Provider Demographics
NPI:1326752577
Name:BURGOS, LILLIANA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LILLIANA
Middle Name:
Last Name:BURGOS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URBANIZACION VEREDAS 29
Mailing Address - Street 2:CAMINO LOS FLAMBOYANES
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:787-362-1440
Mailing Address - Fax:
Practice Address - Street 1:BAY VAL CORPORATION
Practice Address - Street 2:8860 KM 1.2 BO LAS CUEVAS
Practice Address - City:TUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-362-1440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6331103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist