Healthcare Provider Details

I. General information

NPI: 1548221807
Provider Name (Legal Business Name): MIRIAM RENEE MIRABAL-CORDERO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#98, PRINCIPE GUILLERMO ST. ESTANCIAS REALES
GUAYNABO PR
00969-5331
US

IV. Provider business mailing address

SAN JORGE ST SAN JORGE MEDICAL OFFICE BUILDING SUITE #401
SAN JUAN PR
00912-3359
US

V. Phone/Fax

Practice location:
  • Phone: 787-726-1484
  • Fax: 787-268-0972
Mailing address:
  • Phone: 787-726-1484
  • Fax: 787-268-0972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number10378
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: