Provider Demographics
NPI:1801938584
Name:MIRANDA, IDELVIS
Entity type:Individual
Prefix:
First Name:IDELVIS
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SW 52ND AVE
Mailing Address - Street 2:#3A
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-8304
Mailing Address - Country:US
Mailing Address - Phone:786-202-1919
Mailing Address - Fax:
Practice Address - Street 1:11 SW 52ND AVE
Practice Address - Street 2:#3A
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-8304
Practice Address - Country:US
Practice Address - Phone:786-202-1919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL229764376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide