MEDICARE: MARIA DE LOURDES MIRANDA 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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	9535	PR

General Provider Information

NPI Number	:	1629162334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA DE LOURDES MIRANDA MD

Provider Business Mailing Address
First Line	:	PO BOX 6909
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00960-5909
Country	:	US
Telephone Number	:	787-963-1404
Fax Number	:	447-200-2080

Provider Business Practice Location Address
First Line	:	AA3 AVE DON PELAYO
Second Line	:	URB.COVADONGA
City	:	TOA BAJA
State	:	PR
Zip	:	00949-5388
Country	:	US
Telephone Number	:	787-963-1404
Fax Number	:	447-200-2080

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	03/03/2026

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