Provider Demographics
NPI:1558769877
Name:BURGOS VAZQUEZ, ZULEIMA (MA)
Entity Type:Individual
Prefix:
First Name:ZULEIMA
Middle Name:
Last Name:BURGOS VAZQUEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 02 BOX 7211
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00739
Mailing Address - Country:UM
Mailing Address - Phone:787-487-3056
Mailing Address - Fax:
Practice Address - Street 1:RR 02 BOX 7211
Practice Address - Street 2:
Practice Address - City:CIDRA
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00739
Practice Address - Country:UM
Practice Address - Phone:787-487-3056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3987103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist