Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 4040 | CA |
Y | 103T00000X | Psychologist | 4040 | CA |
NPI | 1003425869 |
---|---|
Provider Name | Dr. Reynaldo Vargas JR. |
First Address | Los Angeles, CA 90002-1244 |
Second Address | Los Angeles, CA 90002-1244 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2020 |
Last Update Date | 28/07/2020 |