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NPI Code Detail

MEDICARE: MIRELLA FLORES RANDELMAN PHD

MEDICARE: MIRELLA FLORES RANDELMAN PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC1900XCounseling PsychologistPSY.0005591CO

General Provider Information

NPI Number : 1932548526
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIRELLA FLORES RANDELMAN PHD
Provider Business Mailing Address
First Line : 3876 GOLF VILLAGE LOOP APT 5
Second Line :
City : LAKELAND
State : FL
Zip : 33809-4087
Country : US
Telephone Number : 561-603-2027
Fax Number :
Provider Business Practice Location Address
First Line : 287 LORTON AVE
Second Line :
City : BURLINGAME
State : CA
Zip : 94010-4203
Country : US
Telephone Number : 877-505-7147
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2013
Last Update Date : 06/15/2023

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