Provider Demographics
NPI:1386492270
Name:MIRANDA, BRISEIDA (MT)
Entity type:Individual
Prefix:
First Name:BRISEIDA
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 CALLE PELICANO
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-3490
Mailing Address - Country:US
Mailing Address - Phone:787-695-3027
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL OPHTHALMIC PLAZA
Practice Address - Street 2:SUITE 103
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-798-3176
Practice Address - Fax:787-288-0774
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR580291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory