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General NPI Number Information
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NPI Number | 1558265207
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Entity Type | Organization
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Legal Business Name | LA SOMBRA DEL OMNIPOTENTE, LLC
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Dates
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Enumeration Date | 10/06/2026
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Last Update Date | 10/06/2026
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Provider Practice Location Address
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Address Line | AVE MUNOZ RIVERA #80 SUITE B
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City | CAMUY
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State | PR
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Zip | 00627-2631
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Country | US
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Telephone | 787-219-6405
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Fax | 939-585-0156
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Provider Business Mailing Address
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Address Line | URB LAS VEREDAS 130 CALLE ALELI
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City | CAMUY
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State | PR
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Zip | 00627-0130
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Country | US
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Telephone | 787-214-2067
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Fax | 939-585-0156
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELIEL MIRANDA
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Credential | MD
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Telephone | 787-214-2067
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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 |
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License Number State | NULL
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