Provider Demographics
NPI:1376879031
Name:MIRANDA, CARLOS GUILLERMO (MD)
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:GUILLERMO
Last Name: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 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:305-500-2000
Mailing Address - Fax:
Practice Address - Street 1:904B CYPRESS PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-3456
Practice Address - Country:US
Practice Address - Phone:407-483-1400
Practice Address - Fax:407-483-1405
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-29
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME147423207R00000X
NJ25MA08679200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002521000Medicaid
12076391OtherCAQH
FL002521000Medicaid