Provider Demographics
NPI:1629162334
Name:MIRANDA, MARIA DE LOURDES (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DE LOURDES
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 6909
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-5909
Mailing Address - Country:US
Mailing Address - Phone:787-251-1414
Mailing Address - Fax:
Practice Address - Street 1:AA3 AVE DON PELAYO
Practice Address - Street 2:URB.COVADONGA
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-5388
Practice Address - Country:US
Practice Address - Phone:787-251-1414
Practice Address - Fax:787-765-5147
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2016-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9535207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE41862Medicare UPIN