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General NPI Number Information
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NPI Number | 1720489271
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Entity Type | Individual
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Provider Name | MARIA VERGARA
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Gender | Female
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Dates
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Enumeration Date | 09/15/2014
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 8263 GROVE AVE STE 201
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-3107
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Country | US
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Telephone | 909-579-0708
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Fax | 909-579-0778
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Provider Business Mailing Address
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Address Line | 6255 W SUNSET BLVD FL 21
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City | LOS ANGELES
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State | CA
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Zip | 90028-7422
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Country | US
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Telephone | 323-860-5200
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Fax | 323-467-7119
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 099477-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 123474
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License Number State | CA
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