Provider Demographics
NPI:1558360438
Name:MIRANDA TORRES, NICOLAS J (MD)
Entity Type:Individual
Prefix:
First Name:NICOLAS
Middle Name:J
Last Name:MIRANDA TORRES
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:PO BOX 63
Mailing Address - Street 2:
Mailing Address - City:MOROVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00687-0063
Mailing Address - Country:US
Mailing Address - Phone:787-862-7567
Mailing Address - Fax:
Practice Address - Street 1:5 CALLE BUENA VIS
Practice Address - Street 2:
Practice Address - City:MOROVIS
Practice Address - State:PR
Practice Address - Zip Code:00687-3042
Practice Address - Country:US
Practice Address - Phone:787-862-3035
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14255208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR132358Medicare UPIN
PR2-1624Medicare ID - Type Unspecified