Provider Demographics
NPI:1982978755
Name:MANGUAL, ZAIDA E (MS)
Entity Type:Individual
Prefix:
First Name:ZAIDA
Middle Name:E
Last Name:MANGUAL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:ZAIDA
Other - Middle Name:E
Other - Last Name:MANGUAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:RR 6 BOX 4065
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-9449
Mailing Address - Country:US
Mailing Address - Phone:787-420-1109
Mailing Address - Fax:
Practice Address - Street 1:RR 6 BOX 4065
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-9449
Practice Address - Country:US
Practice Address - Phone:787-420-1109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-26
Last Update Date:2012-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3778103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist