MEDICARE: DR. DAMARIS ACOSTA-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	207R00000X	Internal Medicine Physician	18568	PR
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	18568	PR
3	207RP1001X	Pulmonary Disease Physician	18568	PR

General Provider Information

NPI Number	:	1952536237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAMARIS ACOSTA-MIRANDA MD

Provider Business Mailing Address
First Line	:	PO BOX 70344
Second Line	:	PMB 310
City	:	SAN JUAN
State	:	PR
Zip	:	00936-8344
Country	:	US
Telephone Number	:	787-755-4245
Fax Number	:	787-755-4563

Provider Business Practice Location Address
First Line	:	100 GRAND PASEO BLVD
Second Line	:	SUITE 106-A
City	:	SAN JUAN
State	:	PR
Zip	:	00926-5905
Country	:	US
Telephone Number	:	787-755-4245
Fax Number	:	787-755-4563

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

Provider Enumeration Date	:	05/15/2009
Last Update Date	:	01/25/2017

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