Healthcare Provider Details

I. General information

NPI: 1861426322
Provider Name (Legal Business Name): ESMERALDA MIRANDA LAMA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 12/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TORRE PLAZA LAS AMERICAS STE 614 525 AVE FD ROOSEVELT
SAN JUAN PR
00918-8056
US

IV. Provider business mailing address

LA TORRE DE PLAZA LAS AMERICAS STE 614 525 AVE FD ROOSEVELT
SAN JUAN PR
00918-8056
US

V. Phone/Fax

Practice location:
  • Phone: 787-767-7700
  • Fax: 787-767-7700
Mailing address:
  • Phone: 787-767-7700
  • Fax: 787-767-7700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number012110
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: