Healthcare Provider Details

I. General information

NPI: 1700843356
Provider Name (Legal Business Name): EDUARDO MIRABAL RODRIGUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PEURTO RICO HEALTH CARE GROUP COND SAN VINCENTE 312 SOUTHERN HEALTH CARE GROUP CALLE VICTORIA 1 SECTO MAQUE
GUAYALUCA PR
00784
US

IV. Provider business mailing address

COND SAN VINCENTE 8169 CALLE CONCORDIA SUITE 312
PONCE PR
00717-1563
US

V. Phone/Fax

Practice location:
  • Phone: 787-841-2777
  • Fax: 787-866-3322
Mailing address:
  • Phone: 787-841-2777
  • Fax: 787-848-0007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number8701
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: