Healthcare Provider Details

I. General information

NPI: 1811767064
Provider Name (Legal Business Name): VICMARIE VARGAS ALVAREZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

INT. CARR 112 KM 1.4 SUITE #9
ISABELA PR
00662
US

IV. Provider business mailing address

489 CALLE ORQUIDEA
MOCA PR
00676-4905
US

V. Phone/Fax

Practice location:
  • Phone: 787-460-4616
  • Fax:
Mailing address:
  • Phone: 939-248-6679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7883
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: