Provider Demographics
NPI:1992139307
Name:VARGAS, JACQUELINE BACANI (MA)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:BACANI
Last Name:VARGAS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:BACANI
Other - Last Name:VARGAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:3853 ROSECRANS ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3115
Mailing Address - Country:US
Mailing Address - Phone:619-692-8232
Mailing Address - Fax:619-542-4060
Practice Address - Street 1:3853 ROSECRANS ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3115
Practice Address - Country:US
Practice Address - Phone:619-692-8232
Practice Address - Fax:619-542-4060
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist