Provider Demographics
NPI:1649685298
Name:MIRANDA GONZALEZ, EDGAR JAVIER
Entity type:Individual
Prefix:
First Name:EDGAR
Middle Name:JAVIER
Last Name:MIRANDA GONZALEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65TH INFANTERY AVE, CARR.3 KM. 8.3
Mailing Address - Street 2:HOSPITAL UPR DR. FEDERICO TRILLA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985
Mailing Address - Country:US
Mailing Address - Phone:787-757-1800
Mailing Address - Fax:
Practice Address - Street 1:65TH INFANTERY AVE, CARR.3 KM. 8.3
Practice Address - Street 2:HOSPITAL UPR DR. FEDERICO TRILLA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-757-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR32410-R207P00000X
PR31,661 R390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine