Provider Demographics
NPI:1568919678
Name:MILLAN, LIZA IVETTE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LIZA
Middle Name:IVETTE
Last Name:MILLAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LIZA
Other - Middle Name:I
Other - Last Name:MILLAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:355 CALLE GALILEO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927
Mailing Address - Country:US
Mailing Address - Phone:787-473-3149
Mailing Address - Fax:
Practice Address - Street 1:1479 AVE ASHFORD
Practice Address - Street 2:CONDADO DEL MAR
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-473-3149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4019103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical