Provider Demographics
NPI:1316377492
Name:VARGAS, QUETA (MFT)
Entity Type:Individual
Prefix:MS
First Name:QUETA
Middle Name:
Last Name:VARGAS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 TRANCAS ST
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2900
Mailing Address - Country:US
Mailing Address - Phone:415-721-4100
Mailing Address - Fax:707-255-9597
Practice Address - Street 1:1100 TRANCAS ST
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2900
Practice Address - Country:US
Practice Address - Phone:415-721-4100
Practice Address - Fax:707-255-9597
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 46812106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist