Provider Demographics
NPI:1598902108
Name:QUINONES-MIRANDA, VICTOR R (PSY D)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:R
Last Name:QUINONES-MIRANDA
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 CALLE GLASGOW
Mailing Address - Street 2:URB. COLLEGE PARK
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-4813
Mailing Address - Country:US
Mailing Address - Phone:787-547-7036
Mailing Address - Fax:
Practice Address - Street 1:1850 CALLE GLASGOW
Practice Address - Street 2:URB. COLLEGE PARK
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-4813
Practice Address - Country:US
Practice Address - Phone:787-547-7036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR#3024103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical