Provider Demographics
NPI:1942563796
Name:VARGAS, AMPARO GUADALUPE
Entity Type:Individual
Prefix:
First Name:AMPARO
Middle Name:GUADALUPE
Last Name:VARGAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:VARGAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4447 E KINGS CANYON RD
Mailing Address - Street 2:MODULAR BUILDING E
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93702-3604
Mailing Address - Country:US
Mailing Address - Phone:559-600-4668
Mailing Address - Fax:559-600-4665
Practice Address - Street 1:4447 E KINGS CANYON RD
Practice Address - Street 2:MODULAR BUILDING E
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93702-3604
Practice Address - Country:US
Practice Address - Phone:559-600-4668
Practice Address - Fax:559-600-4665
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health