Healthcare Provider Details

I. General information

NPI: 1427131929
Provider Name (Legal Business Name): MIRLA K ERAUSQUIN COLON O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIRLA K ERAUSQUIN COLON O.D.

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 10/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLAZA CAROLINA MALL LOCAL 245 SECOND FLOOR
CAROLINA PR
00985
US

IV. Provider business mailing address

CONDOMINIO BALCONES DE MONTE REAL APT 6601
CAROLINA PR
00987
US

V. Phone/Fax

Practice location:
  • Phone: 787-701-3165
  • Fax: 787-701-3168
Mailing address:
  • Phone: 787-396-6623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number608
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: