Provider Demographics
NPI:1528009404
Name:SANCHEZ OVALLE, MIRTHA (MD)
Entity Type:Individual
Prefix:MRS
First Name:MIRTHA
Middle Name:
Last Name:SANCHEZ OVALLE
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 1:714 CALLE DURAZNO
Mailing Address - Street 2:CAPARRA TERRACE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920-5011
Mailing Address - Country:US
Mailing Address - Phone:787-646-1353
Mailing Address - Fax:
Practice Address - Street 1:714 CALLE DURAZNO
Practice Address - Street 2:CAPARRA TERRACE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-5011
Practice Address - Country:US
Practice Address - Phone:787-646-1353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12537173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine