Healthcare Provider Details

I. General information

NPI: 1730147216
Provider Name (Legal Business Name): MARIA L MIRANDA CRUZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB TINTILLO GARDENS B 5 CALLE 1
GUAYNABO PR
00966
US

IV. Provider business mailing address

URB. TINTILLO GARDENS B - 5 CALLE 1
GUAYNABO PR
00966-1666
US

V. Phone/Fax

Practice location:
  • Phone: 787-799-9977
  • Fax:
Mailing address:
  • Phone: 787-277-1638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number14533
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: