Provider Demographics
NPI:1437469962
Name:GINES, MIRIAM (PSICOLOGIA)
Entity Type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:
Last Name:GINES
Suffix:
Gender:F
Credentials:PSICOLOGIA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 4036
Mailing Address - Street 2:
Mailing Address - City:CIALES
Mailing Address - State:PR
Mailing Address - Zip Code:00638-4036
Mailing Address - Country:US
Mailing Address - Phone:787-515-2317
Mailing Address - Fax:
Practice Address - Street 1:BO HATO DIEGO CUMBRE CARR 149 KM 5 HECT 1
Practice Address - Street 2:
Practice Address - City:CIALES
Practice Address - State:PR
Practice Address - Zip Code:00638-4036
Practice Address - Country:US
Practice Address - Phone:787-515-2317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3760103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3760OtherLICENSE