Healthcare Provider Details

I. General information

NPI: 1871780239
Provider Name (Legal Business Name): LM BEHAVIORAL PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 10/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GUAYNABO MEDICAL MALL 140 AVE. LAS CUMBRES
GUAYNABO PR
00969
US

IV. Provider business mailing address

35 JC BORBON SUITE 67 PMB-383
GUAYNABO PR
00969
US

V. Phone/Fax

Practice location:
  • Phone: 787-272-1292
  • Fax: 787-287-2487
Mailing address:
  • Phone: 787-272-1292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number16449
License Number StatePR

VIII. Authorized Official

Name: DR. LILIANA Z MIRANDA BROCO
Title or Position: PSYCHIATRIST
Credential: MD
Phone: 787-272-1292