Provider Demographics
NPI:1902321946
Name:MIRANDA, ARMINDA ROSA
Entity type:Individual
Prefix:
First Name:ARMINDA
Middle Name:ROSA
Last Name:MIRANDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 AVE DE LA CONSTITUCION APT 6D
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00901-2301
Mailing Address - Country:US
Mailing Address - Phone:787-409-4145
Mailing Address - Fax:
Practice Address - Street 1:450 DE LA CONSTITUCION AVE
Practice Address - Street 2:APT. 6-D
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00901
Practice Address - Country:US
Practice Address - Phone:787-409-4145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR696103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist