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General NPI Number Information
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NPI Number | 1871780239
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Entity Type | Organization
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Legal Business Name | LM BEHAVIORAL PSC
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 10/01/2007
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Provider Practice Location Address
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Address Line | GUAYNABO MEDICAL MALL 140 AVE. LAS CUMBRES
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City | GUAYNABO
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State | PR
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Zip | 00969
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Country | US
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Telephone | 787-272-1292
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Fax | 787-287-2487
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Provider Business Mailing Address
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Address Line | 35 JC BORBON SUITE 67 PMB-383
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City | GUAYNABO
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State | PR
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Zip | 00969
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Country | US
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Telephone | 787-272-1292
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | DR. LILIANA Z MIRANDA BROCO
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Credential | MD
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Telephone | 787-272-1292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 16449
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License Number State | PR
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