Provider Demographics
NPI:1205116092
Name:GARCIA, JOSE RICARDO VARGAS (MA)
Entity type:Individual
Prefix:
First Name:JOSE RICARDO
Middle Name:VARGAS
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15630 SE 90TH AVE
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-9729
Mailing Address - Country:US
Mailing Address - Phone:503-657-9287
Mailing Address - Fax:
Practice Address - Street 1:15630 SE 90TH AVE
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9729
Practice Address - Country:US
Practice Address - Phone:503-657-9287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator