Healthcare Provider Details

I. General information

NPI: 1831938927
Provider Name (Legal Business Name): CORALYS DEL MAR MIRANDA-MALDONADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 CALLE RIMAC
BARCELONETA PR
00617-9453
US

IV. Provider business mailing address

144 CALLE RIMAC
BARCELONETA PR
00617-9453
US

V. Phone/Fax

Practice location:
  • Phone: 787-450-3756
  • Fax:
Mailing address:
  • Phone: 787-970-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number1330
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: