Healthcare Provider Details

I. General information

NPI: 1538643416
Provider Name (Legal Business Name): RUTH RODRIGUEZ MIRANDA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 02/23/2025
Certification Date: 02/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 AVE HOSTOS STE 15
PONCE PR
00717-0952
US

IV. Provider business mailing address

1123 AVE HOSTOS
PONCE PR
00717-0952
US

V. Phone/Fax

Practice location:
  • Phone: 787-377-1277
  • Fax:
Mailing address:
  • Phone: 787-377-1277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2286
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: