Provider Demographics
NPI:1386430924
Name:MONSERRATE MIRANDA, VIVIANA ANGELI
Entity type:Individual
Prefix:
First Name:VIVIANA
Middle Name:ANGELI
Last Name:MONSERRATE MIRANDA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. HILLSIDE CALLE 2A #C9
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-308-3839
Mailing Address - Fax:
Practice Address - Street 1:310 AVE LOMAS VERDES
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-6638
Practice Address - Country:US
Practice Address - Phone:787-740-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8419183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist