Provider Demographics
NPI:1821148578
Name:MIRANDA, AIDA
Entity Type:Individual
Prefix:
First Name:AIDA
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:URB. DORAVILLE SEC 1
Mailing Address - Street 2:CALLE 5 4-16A
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-796-6653
Mailing Address - Fax:787-796-8747
Practice Address - Street 1:269 CALLE MENDEZ VIGO
Practice Address - Street 2:
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-4904
Practice Address - Country:US
Practice Address - Phone:787-796-1155
Practice Address - Fax:787-796-8747
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR005284183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician