Provider Demographics
NPI:1619167251
Name:WIGGINS, MARIA GUADALUPE
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:GUADALUPE
Last Name:WIGGINS
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 1:18350 HATTERAS ST APT 162
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1693
Mailing Address - Country:US
Mailing Address - Phone:818-896-1161
Mailing Address - Fax:
Practice Address - Street 1:18350 HATTERAS ST APT 162
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-1693
Practice Address - Country:US
Practice Address - Phone:818-896-1161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7068Medicaid
CA7420Medicaid