MEDICARE: LILIANA ZOE MIRANDA M.D.

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	2084P0800X	Psychiatry Physician	M1939	TX
2	2084P0800X	Psychiatry Physician	16449	PR

General Provider Information

NPI Number	:	1598828352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILIANA ZOE MIRANDA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 383
Second Line	:	35 JUAN C BORBON SUITE 67
City	:	GUAYNABO
State	:	PR
Zip	:	00970-0383
Country	:	US
Telephone Number	:	787-272-1292
Fax Number	:	787-287-2487

Provider Business Practice Location Address
First Line	:	140 AVE LAS CUMBRES
Second Line	:
City	:	GUAYNABO
State	:	PR
Zip	:	00969-5523
Country	:	US
Telephone Number	:	787-272-1292
Fax Number	:	787-287-2487

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	04/08/2008

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