Basic Information
| Provider Information | |||||||||
| NPI: | 1033407879 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MIRANDA | ||||||||
| FirstName: | IRVING | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 12493 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331012493 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055854249 | ||||||||
| FaxNumber: | 3053552242 | ||||||||
| Practice Location | |||||||||
| Address1: | 1OO N.W. 170TH ST | ||||||||
| Address2: | SUITE 410 | ||||||||
| City: | NORTH MIAMI BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056546850 | ||||||||
| FaxNumber: | 3056546858 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2011 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | ME127281 | FL | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.