Provider Demographics
NPI:1093803538
Name:SANCHEZ, MIRIN (RPT)
Entity Type:Individual
Prefix:MS
First Name:MIRIN
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BC14 VIA LADOGA
Mailing Address - Street 2:BOSQUE DEL LAGO, ENCANTADA
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-6041
Mailing Address - Country:US
Mailing Address - Phone:787-649-2603
Mailing Address - Fax:
Practice Address - Street 1:AVE.CAMPO RICO A-6
Practice Address - Street 2:CASTELLANA GARDENS
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-752-7897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000366225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
870010OtherMMM PROVIDER NO.
870010OtherMMM PROVIDER NO.