Healthcare Provider Details

I. General information

NPI: 1528009404
Provider Name (Legal Business Name): MIRTHA SANCHEZ OVALLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 06/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 CALLE DURAZNO CAPARRA TERRACE
SAN JUAN PR
00920-5011
US

IV. Provider business mailing address

714 CALLE DURAZNO CAPARRA TERRACE
SAN JUAN PR
00920-5011
US

V. Phone/Fax

Practice location:
  • Phone: 787-646-1353
  • Fax:
Mailing address:
  • Phone: 787-646-1353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number12537
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: