Provider Demographics
NPI:1497720866
Name:MIRABAL, BRENDA (MD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:MIRABAL
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:C10 CALLE 2
Mailing Address - Street 2:VILLAS DEL PILAR
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5449
Mailing Address - Country:US
Mailing Address - Phone:787-777-3535
Mailing Address - Fax:787-759-8193
Practice Address - Street 1:DEPT. OF PEDIATRICS, UPR SCHOOL OF MEDICINE
Practice Address - Street 2:GPO 5067
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936
Practice Address - Country:US
Practice Address - Phone:787-777-3535
Practice Address - Fax:787-759-8193
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR5889208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics