Basic Information
| Provider Information | |||||||||
| NPI: | 1689886525 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MIRANDA | ||||||||
| FirstName: | ADA | ||||||||
| MiddleName: | SMYRNA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | VILLAS DEL CAPITAN SOLANDRA AA 18 BUZON 38 | ||||||||
| Address2: | |||||||||
| City: | ARECIBO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878790732 | ||||||||
| FaxNumber: | 7878790732 | ||||||||
| Practice Location | |||||||||
| Address1: | HOSPITAL METROPOLITANO DR. SUSONI | ||||||||
| Address2: | CALLE PALMA | ||||||||
| City: | ARECIBO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876501030 | ||||||||
| FaxNumber: | 7876501040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080H0002X | 5412 | PR | Y | Allopathic & Osteopathic Physicians | Pediatrics | Hospice and Palliative Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5412 | 01 | PR | STATE LICENSE | OTHER |