Provider Demographics
NPI:1184110314
Name:MIRANDA BARRETO, JOSE ANGEL (MS)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ANGEL
Last Name:MIRANDA BARRETO
Suffix:
Gender:M
Credentials:MS
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 322
Mailing Address - Street 2:
Mailing Address - City:LOIZA
Mailing Address - State:PR
Mailing Address - Zip Code:00772-0322
Mailing Address - Country:US
Mailing Address - Phone:617-290-0816
Mailing Address - Fax:
Practice Address - Street 1:CHALETS DE BAYAMON
Practice Address - Street 2:50 DR RODRIGUEZ
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00952
Practice Address - Country:US
Practice Address - Phone:617-290-0816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRS62758135OtherDRIVERS LICENSE NUMBER