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General NPI Number Information
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NPI Number | 1376630202
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Entity Type | Individual
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Provider Name | JORGE R DE JESUS MIRANDA MD
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Gender | Male
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 04/25/2019
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Provider Practice Location Address
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Address Line | 572 CALLE DE DIEGO SABANA LLANA
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City | SAN JUAN
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State | PR
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Zip | 00924-3815
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Country | US
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Telephone | 787-754-9586
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Fax | 787-754-9589
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Provider Business Mailing Address
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Address Line | 12 CALLE 1 EXT. ALTURAS DE SAN PATRICIO
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City | GUAYNABO
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State | PR
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Zip | 00968-3128
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Country | US
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Telephone | 787-754-9586
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Fax | 787-754-9589
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 6045
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License Number State | PR
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