MEDICARE: JUAN RAMON MIRANDA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	0921	PR

General Provider Information

NPI Number	:	1114944675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN RAMON MIRANDA

Provider Business Mailing Address
First Line	:	PO BOX 21107
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00928-1107
Country	:	US
Telephone Number	:	787-765-5106
Fax Number	:	787-751-5626

Provider Business Practice Location Address
First Line	:	71 CALLE ARZUAGA
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00925-3703
Country	:	US
Telephone Number	:	787-765-5106
Fax Number	:	787-751-5626

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	07/08/2007

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Directions to “ JUAN RAMON MIRANDA ” Practice Location

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