=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376727032
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALICIA MARGARITA MENENDEZ PH D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2007
-----------------------------------------------------
Last Update Date | 12/18/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1801 AVE. PONCE DE LEON SUITE 311
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-727-2424
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 9022760
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00902-2760
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-409-4158
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 591
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------