Healthcare Provider Details

I. General information

NPI: 1649652355
Provider Name (Legal Business Name): KRYSTAL MIRANDA APONTE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2015
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA #2 KM 11.7 BAYAMON
BAYAMON PR
00959
US

IV. Provider business mailing address

PO BOX 1999
BAYAMON PR
00960-1999
US

V. Phone/Fax

Practice location:
  • Phone: 787-474-8282
  • Fax:
Mailing address:
  • Phone: 787-474-8282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number21033
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number21033
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: