Provider Demographics
NPI:1649464108
Name:MIRANDA, CARMEN CELIA (BSN)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:CELIA
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:MRS
Other - First Name:CARMEN
Other - Middle Name:CELIA
Other - Last Name:SERRANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BSN
Mailing Address - Street 1:GJ15 AVE ROBERTO SANCHEZ VILELLA STE 201
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00982-2656
Mailing Address - Country:US
Mailing Address - Phone:787-257-1860
Mailing Address - Fax:787-257-9426
Practice Address - Street 1:GJ15 AVE ROBERTO SANCHEZ VILELLA STE 201
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982-2656
Practice Address - Country:US
Practice Address - Phone:787-257-1860
Practice Address - Fax:787-257-9426
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5453163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse