Healthcare Provider Details

I. General information

NPI: 1801595798
Provider Name (Legal Business Name): BRAINS IN MOTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2023
Last Update Date: 02/28/2023
Certification Date: 02/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLAZA ALEJANDRINO OFICINA 111
GUAYNABO PR
00969
US

IV. Provider business mailing address

130 WINSTON CHURCHILL AVE. PMB 119
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-692-4295
  • Fax:
Mailing address:
  • Phone: 787-692-4295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIA CRISTINA CRUZ MIRANDA
Title or Position: PRESIDENT
Credential: PSY.D
Phone: 787-692-4295