Healthcare Provider Details

I. General information

NPI: 1679400402
Provider Name (Legal Business Name): NOEMI VARGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N MACLAY AVE STE 206
SAN FERNANDO CA
91340-2955
US

IV. Provider business mailing address

6200 DE SOTO AVE APT 35410
WOODLAND HILLS CA
91367-0205
US

V. Phone/Fax

Practice location:
  • Phone: 818-351-6717
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number157379
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: