Provider Demographics
NPI:1578264271
Name:MIRANDA, RAFAEL MANUEL (DC)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:MANUEL
Last Name:MIRANDA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. LAS ALONDRAS CALLE 1
Mailing Address - Street 2:A10
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766-2301
Mailing Address - Country:US
Mailing Address - Phone:787-486-7919
Mailing Address - Fax:
Practice Address - Street 1:URB. LAS ALONDRAS CALLE 1
Practice Address - Street 2:A10
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766-2301
Practice Address - Country:US
Practice Address - Phone:787-486-7919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR908111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor