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General NPI Number Information
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NPI Number | 1619972403
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Entity Type | Individual
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Provider Name | FERMIN C. MIRANDA M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/17/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 566B ALTOS JJ JIMENEZ STREET
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City | SAN JUAN
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State | PR
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Zip | 00918
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Country | US
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Telephone | 787-250-6010
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Fax | 787-250-1116
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Provider Business Mailing Address
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Address Line | 566B ALTOS JJ JIMENEZ STREET
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City | SAN JUAN
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State | PR
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Zip | 00918
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Country | US
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Telephone | 787-250-6010
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Fax | 787-250-1116
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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 | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | 03539
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License Number State | PR
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