=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871537092
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANA B. MIRANDA MD, MPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 208 AVE PONCE DE LEON SUITE 701MERCANTIL PLAZA BLDG.
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00918-1000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-641-1235
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | #A-12 PASEO MEDITERRANEO ST. URB. PARQUE MEDITERRANEO
-----------------------------------------------------
City | GUAYNABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00969
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-793-3363
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 10888
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------