Provider Demographics
NPI:1902914880
Name:MIRANDA, CARLOS J (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:J
Last Name:MIRANDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CARLOS
Other - Middle Name:J
Other - Last Name:MIRANDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2669
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-2669
Mailing Address - Country:US
Mailing Address - Phone:787-787-9315
Mailing Address - Fax:787-785-0685
Practice Address - Street 1:BAYAMON MEDICAL PLAZA SUITE 503
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-787-9315
Practice Address - Fax:787-785-0685
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8501207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC-82767Medicare UPIN