Provider Demographics
NPI:1114245263
Name:MIRANDA, DAMIAN (TEM)
Entity Type:Individual
Prefix:MR
First Name:DAMIAN
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:M
Credentials:TEM
Other - Prefix:MR
Other - First Name:DAMIAN
Other - Middle Name:
Other - Last Name:MIRANDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:TEM
Mailing Address - Street 1:ROAD 115 INT 439 KM 0.5 BO TABLONAL
Mailing Address - Street 2:BUZON 1641
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602
Mailing Address - Country:US
Mailing Address - Phone:787-297-8679
Mailing Address - Fax:
Practice Address - Street 1:2325 AVE ALBIZU CAMPOS
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:PR
Practice Address - Zip Code:00677-2432
Practice Address - Country:US
Practice Address - Phone:787-297-8679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic