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NPI Code Detail

MEDICARE: MARIA VERGARA

MEDICARE: MARIA VERGARA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1-22-63435CA
2106S00000XBehavior TechnicianRBT-18-53072CA

General Provider Information

NPI Number : 1770061814
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIA VERGARA
Provider Business Mailing Address
First Line : PO BOX 33568
Second Line :
City : SAN DIEGO
State : CA
Zip : 92163-3568
Country : US
Telephone Number : 855-223-7123
Fax Number : 619-374-7134
Provider Business Practice Location Address
First Line : 4300 LONG BEACH BLVD STE 100
Second Line :
City : LONG BEACH
State : CA
Zip : 90807-2008
Country : US
Telephone Number : 855-223-7123
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2018
Last Update Date : 01/19/2026

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Directions to “ MARIA VERGARA ” Practice Location

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