Provider Demographics
NPI:1568771228
Name:VERGARA, EVELYN M
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:M
Last Name:VERGARA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:EVELYN
Other - Middle Name:M
Other - Last Name:AGIS VERGARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 E LELAND RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-4961
Mailing Address - Country:US
Mailing Address - Phone:925-439-9628
Mailing Address - Fax:415-401-2741
Practice Address - Street 1:300 E LELAND RD STE 100
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-4961
Practice Address - Country:US
Practice Address - Phone:925-439-9628
Practice Address - Fax:415-401-2741
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program