Provider Demographics
NPI:1437810090
Name:VARGAS RAMIREZ, LIZETH TATIANA
Entity Type:Individual
Prefix:
First Name:LIZETH
Middle Name:TATIANA
Last Name:VARGAS RAMIREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1763 EUGENIA AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-4935
Mailing Address - Country:US
Mailing Address - Phone:510-962-1686
Mailing Address - Fax:
Practice Address - Street 1:1763 EUGENIA AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-4935
Practice Address - Country:US
Practice Address - Phone:510-962-1686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician