Provider Demographics
NPI:1275543563
Name:MIRANDA, FRANCISCO JAVIER (MD)
Entity Type:Individual
Prefix:
First Name:FRANCISCO
Middle Name:JAVIER
Last Name: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 1:517 CALLE CAMINO ESTRELLA
Mailing Address - Street 2:CAMINO DEL SOL
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-4184
Mailing Address - Country:US
Mailing Address - Phone:787-855-6410
Mailing Address - Fax:
Practice Address - Street 1:CALLE 2 B 10 URB VILLA REAL
Practice Address - Street 2:
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:939-717-7410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12490207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD96753Medicare UPIN
PR20116Medicare ID - Type Unspecified