=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215083290
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MIRNA M CINTRON RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CENTRO SAN CRISTOBAL JUANA DIAZ CALLE LA CRUZ #6
-----------------------------------------------------
City | JUANA DIAZ
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00795
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-839-2265
-----------------------------------------------------
Fax | 787-260-1441
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | HC03 BOX 10769
-----------------------------------------------------
City | JUANA DIAZ
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00795-9502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-260-1634
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 3024
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------