Provider Demographics
NPI:1376784595
Name:MEDERO MIRANDA, MARIA DEL C (RPT)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:DEL C
Last Name:MEDERO MIRANDA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-0095
Mailing Address - Country:US
Mailing Address - Phone:787-245-1325
Mailing Address - Fax:
Practice Address - Street 1:CALLE RIO PORTUGUES L7 URB. VILLAS DEL RIO
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-245-1325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR815225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist