Provider Demographics
NPI:1356488530
Name:MIRANDA-GARCIA, ALFONSO (CRNA)
Entity Type:Individual
Prefix:
First Name:ALFONSO
Middle Name:
Last Name:MIRANDA-GARCIA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:ALFONSO
Other - Middle Name:MIRANDA
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 179
Mailing Address - Street 2:
Mailing Address - City:AGUIRRE
Mailing Address - State:PR
Mailing Address - Zip Code:00704
Mailing Address - Country:US
Mailing Address - Phone:787-225-7938
Mailing Address - Fax:
Practice Address - Street 1:10 CASIA AVE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3201
Practice Address - Country:US
Practice Address - Phone:787-225-7938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9200035367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered