Provider Demographics
NPI:1952536237
Name:ACOSTA-MIRANDA, DAMARIS (MD)
Entity type:Individual
Prefix:DR
First Name:DAMARIS
Middle Name:
Last Name:ACOSTA-MIRANDA
Suffix:
Gender:F
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 70344
Mailing Address - Street 2:PMB 310
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8344
Mailing Address - Country:US
Mailing Address - Phone:787-755-4245
Mailing Address - Fax:787-755-4563
Practice Address - Street 1:100 GRAND PASEO BLVD
Practice Address - Street 2:SUITE 106-A
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-5905
Practice Address - Country:US
Practice Address - Phone:787-755-4245
Practice Address - Fax:787-755-4563
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-15
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18568207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine