1487665006 NPI number — CUMIC

Table of content: MIRANDA SCHUNK MA, LPCC (NPI 1013318823)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487665006 NPI number — CUMIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CUMIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487665006
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1786
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAYAMON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00960-1786
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-269-0988
Provider Business Mailing Address Fax Number:
787-995-6925

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVENIDA LAUREL
Provider Second Line Business Practice Location Address:
ESQUINA SANTA JUANITA #100
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00960
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-269-0988
Provider Business Practice Location Address Fax Number:
787-995-6925
Provider Enumeration Date:
08/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CANDELARIO-FERNANDEZ
Authorized Official First Name:
NILDA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENTE UCC
Authorized Official Telephone Number:
787-798-3001

Provider Taxonomy Codes

  • Taxonomy code: 171100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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