Healthcare Provider Details

I. General information

NPI: 1689128829
Provider Name (Legal Business Name): RAE VARGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 10/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 CAMINO DEL REMEDIO
SANTA BARBARA CA
93110-1332
US

IV. Provider business mailing address

315 CAMINO DEL REMEDIO
SANTA BARBARA CA
93110-1332
US

V. Phone/Fax

Practice location:
  • Phone: 805-681-4777
  • Fax: 805-681-5117
Mailing address:
  • Phone: 805-681-4777
  • Fax: 805-681-5117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT115874
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: