Healthcare Provider Details

I. General information

NPI: 1366881260
Provider Name (Legal Business Name): WILLIAM DANIL MIRANDA LOPEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PARQUE CENTRO BO. MONACILLOS
SAN JUAN PR
00918-5000
US

IV. Provider business mailing address

PO BOX 2116
SAN JUAN PR
00922-2116
US

V. Phone/Fax

Practice location:
  • Phone: 787-754-0101
  • Fax:
Mailing address:
  • Phone: 787-754-0101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number19303
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number19303
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: