Provider Demographics
NPI:1063659837
Name:MIRANDA, JENNIFER (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4100 SALZEDO ST
Mailing Address - Street 2:STE 4
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-1751
Mailing Address - Country:US
Mailing Address - Phone:786-227-6811
Mailing Address - Fax:786-732-2377
Practice Address - Street 1:4100 SALZEDO ST
Practice Address - Street 2:STE 4
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-1751
Practice Address - Country:US
Practice Address - Phone:786-227-6811
Practice Address - Fax:786-732-2377
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-14
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME106748207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine