MEDICARE: DR. EDUARDO MIRALLES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	15995	PR

General Provider Information

NPI Number	:	1083695191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDUARDO MIRALLES M.D.

Provider Business Mailing Address
First Line	:	COND LOS ROBLES
Second Line	:	APTO 609A
City	:	SAN JUAN
State	:	PR
Zip	:	00927-4631
Country	:	US
Telephone Number	:	787-314-4895
Fax Number	:	787-274-0342

Provider Business Practice Location Address
First Line	:	1395 CALLE SAN RAFAEL
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00910-3428
Country	:	US
Telephone Number	:	787-723-2950
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	09/26/2011

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