Provider Demographics
NPI:1366456758
Name:AMADOR, MIRTHA DEL S (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRTHA
Middle Name:DEL S
Last Name:AMADOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MIRTHA
Other - Middle Name:
Other - Last Name:AMADOR MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4 AVE LAGUNA
Mailing Address - Street 2:COND LAGUNA GARDENS IV APT 9H
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979
Mailing Address - Country:US
Mailing Address - Phone:787-791-6494
Mailing Address - Fax:787-791-6494
Practice Address - Street 1:4 AVE LAGUNA
Practice Address - Street 2:COND LAGUNA GARDENS IV APT 9H
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979
Practice Address - Country:US
Practice Address - Phone:787-791-6494
Practice Address - Fax:787-791-6494
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2956208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR25642OtherTRIPLE S INC