Provider Demographics
NPI:1366427627
Name:MIRANDA TORRES, MARIO CESAR (MD)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:CESAR
Last Name:MIRANDA TORRES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:VISTA BELLA
Mailing Address - Street 2:CALLE 5 N1
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-787-0826
Mailing Address - Fax:787-251-1287
Practice Address - Street 1:VISTA BELLA
Practice Address - Street 2:CALLE 5 N1
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-787-0826
Practice Address - Fax:787-251-1287
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR2194207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2194OtherSTATE LIC
PR2194OtherSTATE LIC
PRD08595Medicare UPIN