Provider Demographics
NPI:1346937372
Name:MIRALRIO, OWEN J
Entity Type:Individual
Prefix:
First Name:OWEN
Middle Name:J
Last Name:MIRALRIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1926 S 21ST ST # A
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-3603
Mailing Address - Country:US
Mailing Address - Phone:414-333-9993
Mailing Address - Fax:
Practice Address - Street 1:3201 S 16TH ST STE 1000
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4532
Practice Address - Country:US
Practice Address - Phone:414-389-3180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI035833501106376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide