=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275406167
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRANDY VARGAS GERVACIO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2025
-----------------------------------------------------
Last Update Date | 09/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 701 GENERAL PETROLEUM AVE.
-----------------------------------------------------
City | KETTLEMAN CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-386-5702
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 701 GENERAL PETROLEUM AVE.
-----------------------------------------------------
City | KETTLEMAN CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-386-5702
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YS0200X
-----------------------------------------------------
Taxonomy Name | School Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------