Provider Demographics
NPI:1669003315
Name:RODRIGUEZ DE VARGAS, PALOMA
Entity Type:Individual
Prefix:
First Name:PALOMA
Middle Name:
Last Name:RODRIGUEZ DE VARGAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PALOMA
Other - Middle Name:
Other - Last Name:VARGAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3825 W GARDEN GROVE BLVD APT 64
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4854
Mailing Address - Country:US
Mailing Address - Phone:714-566-5740
Mailing Address - Fax:
Practice Address - Street 1:12395 LEWIS ST STE 202
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-4694
Practice Address - Country:US
Practice Address - Phone:714-867-6384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-31
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty