Provider Demographics
NPI:1891238978
Name:VIGUIE, MARIAM ALEIDA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARIAM
Middle Name:ALEIDA
Last Name:VIGUIE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 CARR 8860
Mailing Address - Street 2:CHALETS SEVILLANOS APT 2455
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-903-4436
Mailing Address - Fax:
Practice Address - Street 1:1801 AVE PONCE DE LEON SUITE 411
Practice Address - Street 2:SANTURCE MEDICAL MALL
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-903-4436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5742103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical