Provider Demographics
NPI:1235212283
Name:VIZCARRONDO, MARIA CECILIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:CECILIA
Last Name:VIZCARRONDO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 BO TORTUGO APT 7
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-9770
Mailing Address - Country:US
Mailing Address - Phone:787-272-0407
Mailing Address - Fax:
Practice Address - Street 1:400 BO TORTUGO APT 7
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-9770
Practice Address - Country:US
Practice Address - Phone:787-272-0407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2042103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1798188OtherPR DRIVER LICENCE