Provider Demographics
NPI:1720502008
Name:ERNESTO MIRABAL, M.D., LLC
Entity Type:Organization
Organization Name:ERNESTO MIRABAL, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:MIRABAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-226-8716
Mailing Address - Street 1:1044 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CENTRAL FALLS
Mailing Address - State:RI
Mailing Address - Zip Code:02863-1507
Mailing Address - Country:US
Mailing Address - Phone:401-226-8716
Mailing Address - Fax:
Practice Address - Street 1:1044 BROAD ST
Practice Address - Street 2:
Practice Address - City:CENTRAL FALLS
Practice Address - State:RI
Practice Address - Zip Code:02863-1507
Practice Address - Country:US
Practice Address - Phone:401-722-4086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-28
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11356207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty