Provider Demographics
NPI:1699249995
Name:MUJICA-TRENCHE, NORA ALICIA (PH D)
Entity type:Individual
Prefix:DR
First Name:NORA
Middle Name:ALICIA
Last Name:MUJICA-TRENCHE
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:PO BOX 29727
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0727
Mailing Address - Country:US
Mailing Address - Phone:787-479-2282
Mailing Address - Fax:
Practice Address - Street 1:1275 AVE AMERICO MIRANDA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-1617
Practice Address - Country:US
Practice Address - Phone:787-479-2282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-20
Last Update Date:2019-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2194103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty