Provider Demographics
NPI:1952471591
Name:TRUJILLO MIRANDA, BEATRIZ (MD)
Entity Type:Individual
Prefix:MRS
First Name:BEATRIZ
Middle Name:
Last Name:TRUJILLO MIRANDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 141197
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-1197
Mailing Address - Country:US
Mailing Address - Phone:787-879-5878
Mailing Address - Fax:787-879-5878
Practice Address - Street 1:RODRIQUEZ IRIZARRY STREET #166
Practice Address - Street 2:SUITE #1
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-0000
Practice Address - Country:US
Practice Address - Phone:787-879-5878
Practice Address - Fax:787-879-5878
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR99232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR83455Medicare ID - Type UnspecifiedMEDICARE
PRF88785Medicare UPIN