Provider Demographics
NPI:1598828352
Name:MIRANDA, LILIANA ZOE (MD)
Entity Type:Individual
Prefix:
First Name:LILIANA
Middle Name:ZOE
Last Name:MIRANDA
Suffix:
Gender:F
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 383
Mailing Address - Street 2:35 JUAN C BORBON SUITE 67
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-0383
Mailing Address - Country:US
Mailing Address - Phone:787-272-1292
Mailing Address - Fax:787-287-2487
Practice Address - Street 1:140 AVE LAS CUMBRES
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5523
Practice Address - Country:US
Practice Address - Phone:787-272-1292
Practice Address - Fax:787-287-2487
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM19392084P0800X
PR164492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0026518Medicare PIN
TXI47757Medicare UPIN