=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770276446
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ARLENE GISELLE GARCIA MIRANDA PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2023
-----------------------------------------------------
Last Update Date | 05/30/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | URB HACIENDA DEL NORTE AA3 AVE DON PELAYO
-----------------------------------------------------
City | TOA BAJA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00949-5388
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-251-1414
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 6909
-----------------------------------------------------
City | BAYAMON
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00960-5909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-353-6380
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 7541
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------