Provider Demographics
NPI:1275132318
Name:BALAGUER, MARIA G
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:G
Last Name:BALAGUER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2496
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-2496
Mailing Address - Country:US
Mailing Address - Phone:787-525-4953
Mailing Address - Fax:
Practice Address - Street 1:PORTICOS DE GUAYNABO CALLE 1 VILLEGAS
Practice Address - Street 2:APT 1-201
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00971
Practice Address - Country:US
Practice Address - Phone:787-272-6414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1805103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1999OtherPLAN