Provider Demographics
NPI:1649312927
Name:PINEIRO-VARGAS, WANDA (PSYD)
Entity type:Individual
Prefix:DR
First Name:WANDA
Middle Name:
Last Name:PINEIRO-VARGAS
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 1:7 ST. F19
Mailing Address - Street 2:RIBERAS DEL RIO
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-272-7952
Mailing Address - Fax:
Practice Address - Street 1:7 ST. F19
Practice Address - Street 2:RIBERAS DEL RIO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-272-7952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1796103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical