Provider Demographics
NPI:1366421232
Name:MIRANDA, LOIDA (MD)
Entity type:Individual
Prefix:MRS
First Name:LOIDA
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:MD
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 4283
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-4283
Mailing Address - Country:US
Mailing Address - Phone:787-858-9094
Mailing Address - Fax:787-858-4445
Practice Address - Street 1:CALLE JOSE J ACOSTA
Practice Address - Street 2:# 13
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00694-4283
Practice Address - Country:US
Practice Address - Phone:787-858-9094
Practice Address - Fax:787-858-4445
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9984208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
G04574Medicare UPIN
PR81821Medicare ID - Type Unspecified