MEDICARE: DR. GILBERTO L DE MIRANDA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	11202	PR
2	208D00000X	General Practice Physician	ACN1208	FL

General Provider Information

NPI Number	:	1316940943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GILBERTO L DE MIRANDA M.D.

Provider Business Mailing Address
First Line	:	6675 WESTWOOD BLVD STE 475
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32821-6027
Country	:	US
Telephone Number	:	407-845-0330
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 RIDGE CENTER DR STE 104
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33837-6414
Country	:	US
Telephone Number	:	863-421-9447
Fax Number	:	863-421-1806

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	01/13/2026

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