Provider Demographics
NPI:1619085826
Name:MIR, CECILIA JOSELINA (MD)
Entity Type:Individual
Prefix:MRS
First Name:CECILIA
Middle Name:JOSELINA
Last Name:MIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2070 ST. 1 BOX 405
Mailing Address - Street 2:LOS FRAILES GARDENS
Mailing Address - City:GUYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-3508
Mailing Address - Country:US
Mailing Address - Phone:787-781-3409
Mailing Address - Fax:
Practice Address - Street 1:FD ROOSEVELT AVENUE
Practice Address - Street 2:#1441
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920
Practice Address - Country:US
Practice Address - Phone:787-793-8383
Practice Address - Fax:787-774-4839
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10,164207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G40919Medicare UPIN
0088654Medicare ID - Type Unspecified