=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700843356
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDUARDO MIRABAL RODRIGUEZ MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | PEURTO RICO HEALTH CARE GROUP COND SAN VINCENTE 312 SOUTHERN HEALTH CARE GROUP CALLE VICTORIA 1 SECTO MAQUE
-----------------------------------------------------
City | GUAYALUCA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00784
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-841-2777
-----------------------------------------------------
Fax | 787-866-3322
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | COND SAN VINCENTE 8169 CALLE CONCORDIA SUITE 312
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00717-1563
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-841-2777
-----------------------------------------------------
Fax | 787-848-0007
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 8701
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------