Provider Demographics
NPI:1336982040
Name:GENER BETANCOURT, MIRANDA IRIS (CNM)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:IRIS
Last Name:GENER BETANCOURT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:
Other - Last Name:GENER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8200 SW 117TH AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4826
Mailing Address - Country:US
Mailing Address - Phone:305-226-5651
Mailing Address - Fax:
Practice Address - Street 1:8200 SW 117TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-3856
Practice Address - Country:US
Practice Address - Phone:305-322-3825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNM09493367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife