Provider Demographics
NPI:1205037090
Name:ACOSTA-MIRANDA, ALEX M (MD)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:M
Last Name:ACOSTA-MIRANDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UROLOGIA RCM
Mailing Address - Street 2:PO BOX 29134
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0134
Mailing Address - Country:US
Mailing Address - Phone:787-758-2525
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF UROLOGY A-971
Practice Address - Street 2:MEDICAL SCIENCES CAMPUS UPR
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936-5067
Practice Address - Country:US
Practice Address - Phone:787-767-7072
Practice Address - Fax:787-274-8156
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16101208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2-9270Medicare PIN