Provider Demographics
NPI:1962899922
Name:VICUNA, MARIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:VICUNA
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 1:9416 34TH RD APT A1
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6014
Mailing Address - Country:US
Mailing Address - Phone:347-624-8842
Mailing Address - Fax:
Practice Address - Street 1:9416 34TH RD APT A1
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6014
Practice Address - Country:US
Practice Address - Phone:347-624-8842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator