Provider Demographics
NPI:1427387174
Name:BURGOS VARGAS, VIMARIE (MASTER)
Entity Type:Individual
Prefix:
First Name:VIMARIE
Middle Name:
Last Name:BURGOS VARGAS
Suffix:
Gender:F
Credentials:MASTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PARCELAS LAS CAROLINAS
Mailing Address - Street 2:CALLE AZUCENA 396 ALTOS
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-678-7771
Mailing Address - Fax:787-258-0276
Practice Address - Street 1:435 AVE HOSTOS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3014
Practice Address - Country:US
Practice Address - Phone:787-995-2700
Practice Address - Fax:787-995-2706
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3192103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling