Healthcare Provider Details

I. General information

NPI: 1609847763
Provider Name (Legal Business Name): HECTOR S MIRANDA DELGADO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 DE DIEGO AVE SAN FRANCISCO TOWER SUITE 409
SAN JUAN PR
00923
US

IV. Provider business mailing address

365 DE DIEGO AVE SAN FRANCISCO TOWER SUITE 409
SAN JUAN PR
00923
US

V. Phone/Fax

Practice location:
  • Phone: 787-767-5944
  • Fax: 787-765-5786
Mailing address:
  • Phone: 787-767-5944
  • Fax: 787-765-5786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number9912
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: