Provider Demographics
NPI:1336370733
Name:VARGAS, ALISON MICHELLE (PSYD)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:MICHELLE
Last Name:VARGAS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:MICHELLE
Other - Last Name:FLIPSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:1345 E PUENTE ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-3213
Mailing Address - Country:US
Mailing Address - Phone:213-300-6652
Mailing Address - Fax:
Practice Address - Street 1:1345 E PUENTE ST
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-3213
Practice Address - Country:US
Practice Address - Phone:213-300-6652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-03
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26884103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical