Provider Demographics
NPI:1669711420
Name:MIRANDA, JOSE ADAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ADAN
Last Name:MIRANDA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2423 SW 147TH AVE # 2143
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4082
Mailing Address - Country:US
Mailing Address - Phone:305-575-2505
Mailing Address - Fax:
Practice Address - Street 1:3625 NW 82ND AVE STE 400
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-7602
Practice Address - Country:US
Practice Address - Phone:305-575-2505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-13
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8556103T00000X
TX37019103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist