Healthcare Provider Details

I. General information

NPI: 1962490037
Provider Name (Legal Business Name): MYRNA C MONREAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MYRNA ROMULO CRISOSTOMO MD

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N 11TH ST
HAINES CITY FL
33844-4325
US

IV. Provider business mailing address

1290 GOLFVIEW AVENUE 4TH FLOOR ATTN BILLING DEPARTMENT
BARTOW FL
33830-6740
US

V. Phone/Fax

Practice location:
  • Phone: 863-421-3204
  • Fax: 863-421-3210
Mailing address:
  • Phone: 863-519-7900
  • Fax: 863-519-7696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME37811
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: