Healthcare Provider Details

I. General information

NPI: 1669957056
Provider Name (Legal Business Name): JOSE VARGAS BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2018
Last Update Date: 05/06/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 FOLSOM ST FL 1
SAN FRANCISCO CA
94107-4226
US

IV. Provider business mailing address

8845 LOS OLIVAS CT
STOCKTON CA
95210-1226
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax: 772-675-9100
Mailing address:
  • Phone: 209-819-0073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-66259
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-48274
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: