Provider Demographics
NPI:1407638133
Name:VARGAS, FAITH ELIZABETH
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:ELIZABETH
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 1:9635 JIMZEL RD
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-4041
Mailing Address - Country:US
Mailing Address - Phone:619-346-9029
Mailing Address - Fax:
Practice Address - Street 1:5353 BALTIMORE DR APT 58
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-4628
Practice Address - Country:US
Practice Address - Phone:619-346-9029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-17
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist