Provider Demographics
NPI:1871031187
Name:MYRIAM Z ALLENDE VIGO PSC
Entity Type:Organization
Organization Name:MYRIAM Z ALLENDE VIGO PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MYRIAM
Authorized Official - Middle Name:ZAYDEE
Authorized Official - Last Name:ALLENDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-502-1687
Mailing Address - Street 1:PO BOX 364246
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-4246
Mailing Address - Country:US
Mailing Address - Phone:787-852-5313
Mailing Address - Fax:
Practice Address - Street 1:18 CALLE J FRANCESCHI
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-852-5313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center