Healthcare Provider Details

I. General information

NPI: 1033407879
Provider Name (Legal Business Name): IRVING MIRANDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1OO N.W. 170TH ST SUITE 410
NORTH MIAMI BEACH FL
33169
US

IV. Provider business mailing address

PO BOX 12493
MIAMI FL
33101-2493
US

V. Phone/Fax

Practice location:
  • Phone: 305-654-6850
  • Fax: 305-654-6858
Mailing address:
  • Phone: 305-585-4249
  • Fax: 305-355-2242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME127281
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: