Healthcare Provider Details

I. General information

NPI: 1629162334
Provider Name (Legal Business Name): MARIA DE LOURDES MIRANDA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 11/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AA3 AVE DON PELAYO URB.COVADONGA
TOA BAJA PR
00949-5388
US

IV. Provider business mailing address

PO BOX 6909
BAYAMON PR
00960-5909
US

V. Phone/Fax

Practice location:
  • Phone: 787-251-1414
  • Fax: 787-765-5147
Mailing address:
  • Phone: 787-251-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number9535
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: