Provider Demographics
NPI:1649087560
Name:VARGAS-DOMINGUEZ, MARISOL JEANNETTE
Entity type:Individual
Prefix:
First Name:MARISOL
Middle Name:JEANNETTE
Last Name:VARGAS-DOMINGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARISOL
Other - Middle Name:JEANNETTE
Other - Last Name:VARGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:611 VIA PRIMAVERA CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-3832
Mailing Address - Country:US
Mailing Address - Phone:408-807-7699
Mailing Address - Fax:
Practice Address - Street 1:1066 S WHITE RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-3812
Practice Address - Country:US
Practice Address - Phone:408-729-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker