Provider Demographics
NPI:1306391784
Name:MIRANDA ALVELO, DORICA K (PH D)
Entity type:Individual
Prefix:DR
First Name:DORICA
Middle Name:K
Last Name:MIRANDA ALVELO
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 CALLE AMATISTA
Mailing Address - Street 2:PASEO REAL
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-246-6994
Mailing Address - Fax:
Practice Address - Street 1:285 CALLE MENDEZ VIGO
Practice Address - Street 2:
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-4903
Practice Address - Country:US
Practice Address - Phone:787-246-6994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6313103T00000X, 103TC0700X
FLPY9526103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist