Provider Demographics
NPI:1952130833
Name:PURSCHKE VIGO, KARLA DANIELA
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:DANIELA
Last Name:PURSCHKE VIGO
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 1:890 SW 154TH PATH
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33194-2777
Mailing Address - Country:US
Mailing Address - Phone:786-614-7582
Mailing Address - Fax:
Practice Address - Street 1:8180 NW 36TH ST STE 225
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6664
Practice Address - Country:US
Practice Address - Phone:786-614-7582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-364946103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst