MEDICARE: NICOLAS J MIRANDA TORRES MD

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	208D00000X	General Practice Physician	14255	PR

General Provider Information

NPI Number	:	1558360438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLAS J MIRANDA TORRES MD

Provider Business Mailing Address
First Line	:	PO BOX 63
Second Line	:
City	:	MOROVIS
State	:	PR
Zip	:	00687-0063
Country	:	US
Telephone Number	:	787-862-7567
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 CALLE BUENA VIS
Second Line	:
City	:	MOROVIS
State	:	PR
Zip	:	00687-3042
Country	:	US
Telephone Number	:	787-862-3035
Fax Number	:

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	07/08/2007

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