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General NPI Number Information
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NPI Number | 1316940943
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Entity Type | Individual
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Provider Name | GILBERTO L DE MIRANDA M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 03/05/2024
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Provider Practice Location Address
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Address Line | 6517 TAFT ST
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City | HOLLYWOOD
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State | FL
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Zip | 33024-4062
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Country | US
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Telephone | 954-983-9191
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Fax | 954-983-1152
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Provider Business Mailing Address
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Address Line | 6517 TAFT ST
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City | HOLLYWOOD
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State | FL
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Zip | 33024-4062
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Country | US
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Telephone | 954-983-9191
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ACN1208
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 11202
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License Number State | PR
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