Provider Demographics
NPI:1073517355
Name:ALLENDE-VIGO, MYRIAM ZAHYDEE (MD)
Entity Type:Individual
Prefix:DR
First Name:MYRIAM
Middle Name:ZAHYDEE
Last Name:ALLENDE-VIGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MYRIAM
Other - Middle Name:ZAYDEE
Other - Last Name:ALLENDE-VIGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD MBA
Mailing Address - Street 1:PO BOX 364246
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-4246
Mailing Address - Country:US
Mailing Address - Phone:787-852-5313
Mailing Address - Fax:787-765-9183
Practice Address - Street 1:18 J. FRANCESCHI ST.
Practice Address - Street 2:URB. PEREYO
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3948
Practice Address - Country:US
Practice Address - Phone:787-852-5313
Practice Address - Fax:787-765-9183
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-02
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4962207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR25747Medicare ID - Type Unspecified
PRE31196Medicare UPIN