Healthcare Provider Details

I. General information

NPI: 1366237869
Provider Name (Legal Business Name): DRA LILLIANA BURGOS MIRANDA-PSICOLOGA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 CALLE JOSE CELSO BARBOSA OFICINA B
LAS PIEDRAS PR
00771-3515
US

IV. Provider business mailing address

URB VEREDAS 29 CAMINO FLAMBOYANES
GURABO PR
00778
US

V. Phone/Fax

Practice location:
  • Phone: 787-362-1440
  • Fax:
Mailing address:
  • Phone: 787-362-1440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: LILLIANA BURGOS MIRANDA
Title or Position: OWNER
Credential:
Phone: 787-362-1440