Provider Demographics
NPI:1295590727
Name:MIRANDA OBGYN LLC
Entity type:Organization
Organization Name:MIRANDA OBGYN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MIRANDA RIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-510-2928
Mailing Address - Street 1:PO BOX 2009
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-2009
Mailing Address - Country:US
Mailing Address - Phone:787-510-5029
Mailing Address - Fax:
Practice Address - Street 1:128 CALLE ASHFORD
Practice Address - Street 2:ASHFORD MEDICAL PLAZA SUITE 104
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-510-5029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty