Provider Demographics
NPI:1770612822
Name:MIRANDA-FERRER, MANUEL N (MD)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:N
Last Name:MIRANDA-FERRER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 366204
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-6204
Mailing Address - Country:US
Mailing Address - Phone:787-751-7010
Mailing Address - Fax:787-754-3238
Practice Address - Street 1:735 AVE PONCE DE LEON
Practice Address - Street 2:SUITE 202 TORRE MEDICA AUXILIO MUTUO
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00917-5022
Practice Address - Country:US
Practice Address - Phone:787-751-7010
Practice Address - Fax:787-754-3238
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR7190207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRPE 2358OtherPALIC INS ID
PR0028911OtherAUXILIO PLATINO ID
PR28911OtherTRIPLE S INS ID
PR9360087OtherHUMANA INS ID
PR67973OtherCRUZ AZUL INS ID
PR9360087OtherHUMANA GOLD PLUS ID
PR1913OtherPREF MEDICARE CHOICE ID
PR213127OtherPREFERRED HEALTH ID
PR28911OtherMEDICARE OPTIMO ID
PRPE 2358OtherPALIC INS ID
PR0028911Medicare ID - Type UnspecifiedMEDICARE ID