Provider Demographics
NPI:1326114372
Name:VARGAS-GLADEN, ROSALVA VEGA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROSALVA
Middle Name:VEGA
Last Name:VARGAS-GLADEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ROSALVA
Other - Middle Name:VEGA
Other - Last Name:VARGAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:240 MONROE DR
Mailing Address - Street 2:#407
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-1067
Mailing Address - Country:US
Mailing Address - Phone:650-804-1736
Mailing Address - Fax:408-846-2419
Practice Address - Street 1:290 I O O F AVE
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-5204
Practice Address - Country:US
Practice Address - Phone:408-846-2416
Practice Address - Fax:408-846-2419
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT 46940106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA50366OtherMFTI