Healthcare Provider Details

I. General information

NPI: 1316974868
Provider Name (Legal Business Name): LIZA E. SAN MIGUEL-MONTES PSY. D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB MANSIONES DE VILLANOVA #E1-16 CALLE C
SAN JUAN PR
00926
US

IV. Provider business mailing address

URB MANSIONES DE VILLANOVA #E1-16 CALLE C
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-415-5872
  • Fax:
Mailing address:
  • Phone: 787-415-5872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2598
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number2598
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: