Healthcare Provider Details

I. General information

NPI: 1073240131
Provider Name (Legal Business Name): VERONICA VARGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3924 RIVERVIEW DR
RIVERSIDE CA
92509-6611
US

IV. Provider business mailing address

15645 MONICA CT
FONTANA CA
92336-8739
US

V. Phone/Fax

Practice location:
  • Phone: 951-416-1572
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number156789
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: