Healthcare Provider Details

I. General information

NPI: 1962845545
Provider Name (Legal Business Name): DELIMAR MIRANDA-VIERA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2013
Last Update Date: 10/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB INDUSTRIAL REPARADA 2 396 CALLE DR LUIS F SALA
PONCE PR
00716
US

IV. Provider business mailing address

2070 CALLE COLINA
PONCE PR
00730-4139
US

V. Phone/Fax

Practice location:
  • Phone: 787-848-2575
  • Fax:
Mailing address:
  • Phone: 787-247-1949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number19576
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number19576
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: