Provider Demographics
NPI:1801992508
Name:MIRANDA, LUIS E (MD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:E
Last Name:MIRANDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11987
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-1987
Mailing Address - Country:US
Mailing Address - Phone:787-780-6237
Mailing Address - Fax:787-780-6374
Practice Address - Street 1:INSTITUTO SAN PABLO
Practice Address - Street 2:SUITE 308
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-780-6237
Practice Address - Fax:787-780-6374
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2203207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0091688Medicare ID - Type Unspecified
C83460Medicare UPIN