Provider Demographics
NPI:1982236857
Name:MIRANDA, OLGA LIDIA
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:LIDIA
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 1:13541 SW 11TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-1846
Mailing Address - Country:US
Mailing Address - Phone:305-549-0331
Mailing Address - Fax:
Practice Address - Street 1:13541 SW 11TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-1846
Practice Address - Country:US
Practice Address - Phone:305-549-0331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator