MEDICARE: DR. ENID PAGAN 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	10041	PR

General Provider Information

NPI Number	:	1740285626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ENID PAGAN MIRANDA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 3571
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00958-0571
Country	:	US
Telephone Number	:	787-785-2870
Fax Number	:	787-288-4152

Provider Business Practice Location Address
First Line	:	MARGINAL MAGNOLIA GARDENS A35 CALLE 1
Second Line	:	MAGNOLIA GARDENS
City	:	BAYAMON
State	:	PR
Zip	:	00956
Country	:	US
Telephone Number	:	787-785-2870
Fax Number	:	787-288-4152

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	11/14/2013

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