Provider Demographics
NPI:1740603471
Name:MIRALLES, GINES D (MD)
Entity Type:Individual
Prefix:DR
First Name:GINES
Middle Name:D
Last Name:MIRALLES
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 1:2235 VIA FRESA
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-6944
Mailing Address - Country:US
Mailing Address - Phone:858-784-3070
Mailing Address - Fax:
Practice Address - Street 1:2235 VIA FRESA
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-6944
Practice Address - Country:US
Practice Address - Phone:858-784-3070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-31
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC54325207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCF30363Medicare UPIN