1821289414 NPI number — DR. JOSE FRANCISCO MIRO MD, FAAPMR

Table of content: DR. JOSE FRANCISCO MIRO MD, FAAPMR (NPI 1821289414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821289414 NPI number — DR. JOSE FRANCISCO MIRO MD, FAAPMR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIRO
Provider First Name:
JOSE
Provider Middle Name:
FRANCISCO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, FAAPMR
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:
1821289414
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 367056
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00936-7056
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-590-1932
Provider Business Mailing Address Fax Number:
787-551-7316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1003 CALLE ACAPULCO
Provider Second Line Business Practice Location Address:
2
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00920-4054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-590-1932
Provider Business Practice Location Address Fax Number:
787-551-7316
Provider Enumeration Date:
08/07/2007

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: 208100000X , with the licence number:  16231 , 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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