Healthcare Provider Details

I. General information

NPI: 1124168273
Provider Name (Legal Business Name): WILLIAM MIRANDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 04/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TORRE SAN PABLO SUITE 605
BAYAMON PR
00961
US

IV. Provider business mailing address

PO BOX 1759
BAYAMON PR
00960-1759
US

V. Phone/Fax

Practice location:
  • Phone: 787-787-0753
  • Fax: 787-798-5900
Mailing address:
  • Phone: 787-787-0753
  • Fax: 787-798-5900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number3913
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: