Provider Demographics
NPI:1447748207
Name:CASTRO CHANDRI, MIRIAM HAYDEE (MD)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:HAYDEE
Last Name:CASTRO CHANDRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SAN IGNACIO
Mailing Address - Street 2:1707 SAN GUILLERMO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927
Mailing Address - Country:US
Mailing Address - Phone:787-628-8228
Mailing Address - Fax:
Practice Address - Street 1:SAN IGNACIO
Practice Address - Street 2:1707 SAN GUILLERMO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927
Practice Address - Country:US
Practice Address - Phone:787-628-8228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14362I390200000X
PR21008208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program