Healthcare Provider Details

I. General information

NPI: 1992761852
Provider Name (Legal Business Name): CORAL CASALS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 CALLE PAVIA PAVIA MEDICAL PLAZA SUITE 210
SANTURCE PR
00909-2239
US

IV. Provider business mailing address

611 CALLE PAVIA PAVIA MEDICAL PLAZA SUITE 210
SANTURCE PR
00909-2239
US

V. Phone/Fax

Practice location:
  • Phone: 787-728-2318
  • Fax: 787-728-2359
Mailing address:
  • Phone: 787-728-2318
  • Fax: 787-728-2359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14137
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: