Provider Demographics
NPI:1003425869
Name:VARGAS, REYNALDO JR (PSYD, LEP)
Entity Type:Individual
Prefix:DR
First Name:REYNALDO
Middle Name:
Last Name:VARGAS
Suffix:JR
Gender:M
Credentials:PSYD, LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8811 MARY AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90002-1244
Mailing Address - Country:US
Mailing Address - Phone:619-746-0679
Mailing Address - Fax:
Practice Address - Street 1:8811 MARY AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90002-1244
Practice Address - Country:US
Practice Address - Phone:619-746-0679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4040103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist