Provider Demographics
NPI:1700843356
Name:MIRABAL RODRIGUEZ, EDUARDO (MD)
Entity Type:Individual
Prefix:MR
First Name:EDUARDO
Middle Name:
Last Name:MIRABAL RODRIGUEZ
Suffix:
Gender:M
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:COND SAN VINCENTE
Mailing Address - Street 2:8169 CALLE CONCORDIA SUITE 312
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1563
Mailing Address - Country:US
Mailing Address - Phone:787-841-2777
Mailing Address - Fax:787-848-0007
Practice Address - Street 1:PEURTO RICO HEALTH CARE GROUP COND SAN VINCENTE 312
Practice Address - Street 2:SOUTHERN HEALTH CARE GROUP CALLE VICTORIA 1 SECTO MAQUE
Practice Address - City:GUAYALUCA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-841-2777
Practice Address - Fax:787-866-3322
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8701207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
0081479HOtherMEDICARE SHCB
0081479AOtherMEDICARE SHCB
0081480GOtherMEDICARE PCAC
0081479HOtherMEDICARE SHCB
83036Medicare ID - Type Unspecified