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General NPI Number Information
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NPI Number | 1669176053
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Entity Type | Individual
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Provider Name | ALICIA SAN MIGUEL PHD
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Gender | Female
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Dates
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Enumeration Date | 03/29/2023
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Last Update Date | 03/29/2023
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Provider Practice Location Address
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Address Line | 815 MARKET ST
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City | GALVESTON
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State | TX
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Zip | 77550-2725
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Country | US
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Telephone | 409-770-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 1607 PALCIO REAL DR
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City | HOUSTON
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State | TX
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Zip | 77047-4491
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Country | US
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Telephone | 832-289-2869
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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