Healthcare Provider Details

I. General information

NPI: 1831479914
Provider Name (Legal Business Name): VERONICA MIRANDA-LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CALLE CASIA BO. MONACILLOS VA CARIBBEAN HEALTHCARE SYSTEM
SAN JUAN PR
00921
US

IV. Provider business mailing address

10 CALLE CASIA BARRIO MONACILLOS
SAN JUAN PR
00921
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-7582
  • Fax:
Mailing address:
  • Phone: 787-754-0101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number18775
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number18775
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: