Provider Demographics
NPI:1548221807
Name:MIRABAL-CORDERO, MIRIAM RENEE (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:RENEE
Last Name:MIRABAL-CORDERO
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 JORGE ST SAN JORGE MEDICAL OFFICE BUILDING
Mailing Address - Street 2:SUITE #401
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00912-3359
Mailing Address - Country:US
Mailing Address - Phone:787-726-1484
Mailing Address - Fax:787-268-0972
Practice Address - Street 1:#98, PRINCIPE GUILLERMO ST.
Practice Address - Street 2:ESTANCIAS REALES
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5331
Practice Address - Country:US
Practice Address - Phone:787-726-1484
Practice Address - Fax:787-268-0972
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR103782080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology