Provider Demographics
NPI:1871793190
Name:VALENCIA MIRANDA, MAGDA
Entity type:Individual
Prefix:
First Name:MAGDA
Middle Name:
Last Name:VALENCIA MIRANDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ESQUINA BOULEVARD LEVITTOWN LAKES T.B.
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-630-0000
Mailing Address - Fax:787-779-5289
Practice Address - Street 1:ESQUINA BOULEVARD LEVITTOWN LAKES T.B.
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-630-0000
Practice Address - Fax:787-779-5289
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2222103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical