Provider Demographics
NPI:1689352577
Name:MIRANDA, LUZ MARIA
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:MARIA
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:EDIF. SAN JUAN HEALTH CENTRE
Mailing Address - Street 2:150 AVE. DE DIEGO
Mailing Address - City:SAN JUAN PR
Mailing Address - State:PR
Mailing Address - Zip Code:00907
Mailing Address - Country:US
Mailing Address - Phone:787-725-8073
Mailing Address - Fax:
Practice Address - Street 1:EDIF. SAN JUAN HEALTH CENTRE
Practice Address - Street 2:150 AVE. DE DIEGO
Practice Address - City:SAN JUAN PR
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-725-8073
Practice Address - Fax:787-725-1721
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5283183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician