Provider Demographics
NPI:1275406167
Name:VARGAS GERVACIO, BRANDY
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:VARGAS GERVACIO
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 1:701 GENERAL PETROLEUM AVE.
Mailing Address - Street 2:
Mailing Address - City:KETTLEMAN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:93239
Mailing Address - Country:US
Mailing Address - Phone:559-386-5702
Mailing Address - Fax:
Practice Address - Street 1:701 GENERAL PETROLEUM AVE.
Practice Address - Street 2:
Practice Address - City:KETTLEMAN CITY
Practice Address - State:CA
Practice Address - Zip Code:93239
Practice Address - Country:US
Practice Address - Phone:559-386-5702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-26
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool