Basic Information
| Provider Information | |||||||||
| NPI: | 1649211814 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIRANDA | ||||||||
| FirstName: | ERNESTO | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6614 SW 114TH PL | ||||||||
| Address2: | UNIT # H | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331731781 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055951842 | ||||||||
| FaxNumber: | 3055959624 | ||||||||
| Practice Location | |||||||||
| Address1: | 7928 SW 8TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331444209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052615000 | ||||||||
| FaxNumber: | 3052623564 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207QA0505X | ME66050 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine |
ID Information
| ID | Type | State | Issuer | Description | ME 66050 | 01 | FL | LICENSE NUMBER | OTHER |