Provider Demographics
NPI:1972578284
Name:DE LA CRUZ MIRANDA, ANTONIO A (MD)
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:A
Last Name:DE LA CRUZ MIRANDA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:B-17 CALLE POPPY
Mailing Address - Street 2:PARQUE FORESTAL
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-798-7070
Mailing Address - Fax:787-787-2107
Practice Address - Street 1:CARIMED PLZ
Practice Address - Street 2:B-1 CALLE SANTA CRUZ SUITE 403-404
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6928
Practice Address - Country:US
Practice Address - Phone:787-798-7070
Practice Address - Fax:787-787-2107
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR12964207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR9610027OtherHUMANA
PR81409OtherTRIPLE S
PRFJ013ZMedicare PIN
PRH11695Medicare UPIN