Provider Demographics
NPI:1649211814
Name:MIRANDA, ERNESTO J (MD)
Entity Type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:J
Last Name:MIRANDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6614 SW 114TH PL
Mailing Address - Street 2:UNIT # H
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1781
Mailing Address - Country:US
Mailing Address - Phone:305-595-1842
Mailing Address - Fax:305-595-9624
Practice Address - Street 1:7928 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4209
Practice Address - Country:US
Practice Address - Phone:305-261-5000
Practice Address - Fax:305-262-3564
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME66050207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME 66050OtherLICENSE NUMBER
FL23939Medicare ID - Type Unspecified
FLME 66050OtherLICENSE NUMBER
FLF76312Medicare UPIN