Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 258899 | NY |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | D77377 | MD |
Y | 207YP0228X | Pediatric Otolaryngology | ME123156 | FL |
NPI | 1487897500 |
---|---|
Provider Name | Dr. Jiovani Miranda Visaya |
First Address | Boynton Beach, FL 33437 |
Second Address | Boynton Beach, FL 33437 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2009 |
Last Update Date | 26/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
015151100 | (05) | FL |