Provider Demographics
NPI:1992937668
Name:MIRANDA, ELIONEXIS (EMT-P)
Entity type:Individual
Prefix:MR
First Name:ELIONEXIS
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:M
Credentials:EMT-P
Other - Prefix:MR
Other - First Name:ELIONEXIS
Other - Middle Name:
Other - Last Name:MIRANDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EMT-P
Mailing Address - Street 1:RIO GRANDE RINCON
Mailing Address - Street 2:HC 02 BOX 23330
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00685
Mailing Address - Country:UM
Mailing Address - Phone:787-933-5582
Mailing Address - Fax:
Practice Address - Street 1:414 KM 2.8 RIO GRANDE RINCON
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:PR
Practice Address - Zip Code:00677
Practice Address - Country:US
Practice Address - Phone:817-933-5582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-14
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PREMT-P 2018146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic