Provider Demographics
NPI:1285791038
Name:MIRANDA, HILDA V (PHD)
Entity type:Individual
Prefix:
First Name:HILDA
Middle Name:V
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64
Mailing Address - Street 2:
Mailing Address - City:MOROVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00687-0064
Mailing Address - Country:US
Mailing Address - Phone:787-862-2070
Mailing Address - Fax:787-862-2070
Practice Address - Street 1:31 CALLE PRINCIPAL
Practice Address - Street 2:
Practice Address - City:MOROVIS
Practice Address - State:PR
Practice Address - Zip Code:00687-3053
Practice Address - Country:US
Practice Address - Phone:787-862-2070
Practice Address - Fax:787-862-2070
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1610183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR02116OtherTRIPLE-S PROVIDER NUMBER