Provider Demographics
NPI:1891810230
Name:HERNANDEZ MIRANDA, VICTOR MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:MANUEL
Last Name:HERNANDEZ MIRANDA
Suffix:
Gender:M
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 7103
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-7103
Mailing Address - Country:US
Mailing Address - Phone:787-535-1001
Mailing Address - Fax:787-535-1012
Practice Address - Street 1:14TH STREET
Practice Address - Street 2:MENNONITE GENERAL HOSPITAL IN CAYEY EMERGENCY ROOM
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00737-3130
Practice Address - Country:US
Practice Address - Phone:787-535-1001
Practice Address - Fax:787-535-1012
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR5903207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC79586Medicare UPIN