MEDICARE: DR. LAURA TRINIDAD PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	1800	PR
2	103TC0700X	Clinical Psychologist	1800	PR
3	103TF0200X	Forensic Psychologist	1800	PR

General Provider Information

NPI Number	:	1558410803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA TRINIDAD PH.D.

Provider Business Mailing Address
First Line	:	403 CALLE DEL PARQUE
Second Line	:	PISO 5
City	:	SAN JUAN
State	:	PR
Zip	:	00912-3709
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	403 CALLE DEL PARQUE
Second Line	:	PISO 5
City	:	SAN JUAN
State	:	PR
Zip	:	00912-3709
Country	:	US
Telephone Number	:	787-721-4960
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	07/13/2007

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