Provider Demographics
NPI:1366237869
Name:DRA LILLIANA BURGOS MIRANDA-PSICOLOGA
Entity type:Organization
Organization Name:DRA LILLIANA BURGOS MIRANDA-PSICOLOGA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LILLIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGOS MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-362-1440
Mailing Address - Street 1:URB VEREDAS
Mailing Address - Street 2:29 CAMINO FLAMBOYANES
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:787-362-1440
Mailing Address - Fax:
Practice Address - Street 1:152 CALLE JOSE CELSO BARBOSA
Practice Address - Street 2:OFICINA B
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771-3515
Practice Address - Country:US
Practice Address - Phone:787-362-1440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-14
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty