Provider Demographics
NPI:1518188309
Name:MIRANDA, LUZ M (PSYCD)
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:M
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:PSYCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 CALLE ALAMO
Mailing Address - Street 2:CUIDAD JARDIN 1
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-9817
Mailing Address - Country:US
Mailing Address - Phone:787-510-9382
Mailing Address - Fax:
Practice Address - Street 1:23 CALLE ALAMO
Practice Address - Street 2:CUIDAD JARDIN 1
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-9817
Practice Address - Country:US
Practice Address - Phone:787-510-9382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR695103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical