Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-19-76932 | CA |
NPI | 1003371303 |
---|---|
Provider Name | Philip Andrew Vargas |
First Address | Irvine, CA 92606-2417 |
Second Address | Carlsbad, CA 92008-2374 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2019 |
Last Update Date | 31/01/2019 |