Provider Demographics
NPI:1790674885
Name:BURGOS MIRANDA, YATZIMAR (PHARMD)
Entity type:Individual
Prefix:
First Name:YATZIMAR
Middle Name:
Last Name:BURGOS MIRANDA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. LAS AMERICAS BB 11 CALLE 7
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-2003
Mailing Address - Country:US
Mailing Address - Phone:787-459-7063
Mailing Address - Fax:
Practice Address - Street 1:URB. LAS AMERICAS BB 11 CALLE 7
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-2003
Practice Address - Country:US
Practice Address - Phone:787-459-7063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist