Provider Demographics
NPI:1538622824
Name:VARGAS, MAYRA STEPHANIE
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:STEPHANIE
Last Name:VARGAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 MARIPOSA DR
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:CA
Mailing Address - Zip Code:95620-2544
Mailing Address - Country:US
Mailing Address - Phone:760-705-5700
Mailing Address - Fax:
Practice Address - Street 1:5918 FALLSTAFF ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95835-2705
Practice Address - Country:US
Practice Address - Phone:916-761-5373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant