Provider Demographics
NPI:1902139710
Name:VARGAS, VICENTE ANDRES
Entity Type:Individual
Prefix:MR
First Name:VICENTE
Middle Name:ANDRES
Last Name:VARGAS
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:VICENTE
Other - Middle Name:
Other - Last Name:VARGAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:IMF
Mailing Address - Street 1:1625 E MAIN ST
Mailing Address - Street 2:STE. 200
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-5211
Mailing Address - Country:US
Mailing Address - Phone:619-441-1907
Mailing Address - Fax:619-441-1908
Practice Address - Street 1:1625 E MAIN ST
Practice Address - Street 2:STE. 200
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-5211
Practice Address - Country:US
Practice Address - Phone:619-441-1907
Practice Address - Fax:619-441-1908
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health