Provider Demographics
NPI:1013335579
Name:MIRANDA VICENTE, OLGA NYDIA (MD)
Entity Type:Individual
Prefix:DR
First Name:OLGA
Middle Name:NYDIA
Last Name:MIRANDA VICENTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 NW 41ST ST
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6202
Mailing Address - Country:US
Mailing Address - Phone:056-425-3663
Mailing Address - Fax:305-644-6407
Practice Address - Street 1:445 E 25TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3810
Practice Address - Country:US
Practice Address - Phone:305-642-5366
Practice Address - Fax:305-644-6407
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-02
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME130255207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine