Provider Demographics
NPI:1659498277
Name:MIRANDA, NOHARA
Entity Type:Individual
Prefix:
First Name:NOHARA
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 CALLE BALDORIOTY
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-3122
Mailing Address - Country:US
Mailing Address - Phone:787-825-2555
Mailing Address - Fax:787-803-1668
Practice Address - Street 1:27 CALLE BALDORIOTY
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769-3122
Practice Address - Country:US
Practice Address - Phone:787-825-2555
Practice Address - Fax:787-803-1668
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4703183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician