Provider Demographics
NPI:1033792270
Name:WIGGINS, MARGARET ELLENORA
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:ELLENORA
Last Name:WIGGINS
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 1:3636 4TH AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4294
Mailing Address - Country:US
Mailing Address - Phone:858-964-0722
Mailing Address - Fax:
Practice Address - Street 1:3636 4TH AVE STE 310
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4294
Practice Address - Country:US
Practice Address - Phone:858-964-0722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34356103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical