=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831890573
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIRANDA MEDICAL SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2023
-----------------------------------------------------
Last Update Date | 08/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARR. 102 KM. 36.0 BO. MINILLAS SUITE #1
-----------------------------------------------------
City | SAN GERMAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00683
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-978-7225
-----------------------------------------------------
Fax | 787-680-0814
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1675
-----------------------------------------------------
City | SAN GERMAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00683-1675
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-978-7225
-----------------------------------------------------
Fax | 787-680-0814
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JORGE MIRANDA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-949-6592
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------