1366237869 NPI number — DRA LILLIANA BURGOS MIRANDA-PSICOLOGA

Table of content: (NPI 1366237869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366237869 NPI number — DRA LILLIANA BURGOS MIRANDA-PSICOLOGA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRA LILLIANA BURGOS MIRANDA-PSICOLOGA
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:
1366237869
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
URB VEREDAS
Provider Second Line Business Mailing Address:
29 CAMINO FLAMBOYANES
Provider Business Mailing Address City Name:
GURABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00778
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-362-1440
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
152 CALLE JOSE CELSO BARBOSA
Provider Second Line Business Practice Location Address:
OFICINA B
Provider Business Practice Location Address City Name:
LAS PIEDRAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00771-3515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-362-1440
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/14/2025

Additional Information

Authorized Official

Authorized Official Last Name:
BURGOS MIRANDA
Authorized Official First Name:
LILLIANA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
787-362-1440

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC1900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TP2701X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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