1689886525 NPI number — DR. ADA SMYRNA MIRANDA M.D.

Table of content: DR. ADA SMYRNA MIRANDA M.D. (NPI 1689886525)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689886525 NPI number — DR. ADA SMYRNA MIRANDA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIRANDA
Provider First Name:
ADA
Provider Middle Name:
SMYRNA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689886525
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
VILLAS DEL CAPITAN SOLANDRA AA 18 BUZON 38
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARECIBO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-879-0732
Provider Business Mailing Address Fax Number:
787-879-0732

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HOSPITAL METROPOLITANO DR. SUSONI
Provider Second Line Business Practice Location Address:
CALLE PALMA
Provider Business Practice Location Address City Name:
ARECIBO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-650-1030
Provider Business Practice Location Address Fax Number:
787-650-1040
Provider Enumeration Date:
05/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080H0002X , with the licence number:  5412 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5412 . This is a "STATE LICENSE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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