Healthcare Provider Details

I. General information

NPI: 1235929985
Provider Name (Legal Business Name): ANA MARICARMEN VARGAS JULCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 39TH ST
RICHMOND CA
94805-2212
US

IV. Provider business mailing address

6501 RAYMOND ST APT B
OAKLAND CA
94609-1187
US

V. Phone/Fax

Practice location:
  • Phone: 510-412-5930
  • Fax: 510-412-0567
Mailing address:
  • Phone: 510-365-7646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number165012
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: