Healthcare Provider Details

I. General information

NPI: 1144478249
Provider Name (Legal Business Name): ANGEL R MUNOZ MIRABAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 VINE ST
CINCINNATI OH
45220-2213
US

IV. Provider business mailing address

5150 LINTON BLVD STE 250
DELRAY BEACH FL
33484-6528
US

V. Phone/Fax

Practice location:
  • Phone: 513-861-3100
  • Fax: 513-475-6534
Mailing address:
  • Phone: 561-638-7577
  • Fax: 561-638-9322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberME130345
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number48584
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number17856
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: