Provider Demographics
NPI:1851681795
Name:GONZALEZ-VARGAS, BRENDA LETICIA (BA)
Entity type:Individual
Prefix:MISS
First Name:BRENDA
Middle Name:LETICIA
Last Name:GONZALEZ-VARGAS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22366 FULLER AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-6226
Mailing Address - Country:US
Mailing Address - Phone:510-300-3138
Mailing Address - Fax:510-758-8872
Practice Address - Street 1:22366 FULLER AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-6226
Practice Address - Country:US
Practice Address - Phone:510-300-3138
Practice Address - Fax:510-785-8872
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker