Healthcare Provider Details

I. General information

NPI: 1750990057
Provider Name (Legal Business Name): GRISELDA VARGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30807 LOMA LINDA RD
TEMECULA CA
92592-5786
US

IV. Provider business mailing address

30807 LOMA LINDA RD
TEMECULA CA
92592-5786
US

V. Phone/Fax

Practice location:
  • Phone: 951-533-1132
  • Fax:
Mailing address:
  • Phone: 951-533-1132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-87445
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: