Provider Demographics
NPI:1962490037
Name:MONREAL, MYRNA C (MD)
Entity Type:Individual
Prefix:
First Name:MYRNA
Middle Name:C
Last Name:MONREAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MYRNA
Other - Middle Name:ROMULO
Other - Last Name:CRISOSTOMO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1290 GOLFVIEW AVENUE
Mailing Address - Street 2:4TH FLOOR ATTN BILLING DEPARTMENT
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-6740
Mailing Address - Country:US
Mailing Address - Phone:863-519-7900
Mailing Address - Fax:863-519-7696
Practice Address - Street 1:111 N 11TH ST
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-4325
Practice Address - Country:US
Practice Address - Phone:863-421-3204
Practice Address - Fax:863-421-3210
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME37811207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067027800Medicaid
53652ZMedicare ID - Type Unspecified
D86020Medicare UPIN