1013809912 NPI number — JONATHAN ANDRES MIRANDA MALDONADO MS

Table of content: JONATHAN ANDRES MIRANDA MALDONADO MS (NPI 1013809912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013809912 NPI number — JONATHAN ANDRES MIRANDA MALDONADO MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIRANDA MALDONADO
Provider First Name:
JONATHAN
Provider Middle Name:
ANDRES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS
Provider Gender Code:
M

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:
1013809912
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
URB. BOSQUE DEL LAGO-ENCANTADA
Provider Second Line Business Mailing Address:
BF-17, CALLE PLAZA #14
Provider Business Mailing Address City Name:
TRUJILLO ALTO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00976
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-451-7041
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EXPLORA CENTRO ACADEMICO Y TERAPEUTICO
Provider Second Line Business Practice Location Address:
CALLE CARAZO
Provider Business Practice Location Address City Name:
GUAYNABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00969-5717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-710-1600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2025

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: 235Z00000X , with the licence number:  4544 , 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)





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