Provider Demographics
NPI:1831938927
Name:MIRANDA-MALDONADO, CORALYS DEL MAR
Entity type:Individual
Prefix:
First Name:CORALYS
Middle Name:DEL MAR
Last Name:MIRANDA-MALDONADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 CALLE RIMAC
Mailing Address - Street 2:
Mailing Address - City:BARCELONETA
Mailing Address - State:PR
Mailing Address - Zip Code:00617-9453
Mailing Address - Country:US
Mailing Address - Phone:787-970-8100
Mailing Address - Fax:
Practice Address - Street 1:144 CALLE RIMAC
Practice Address - Street 2:
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617-9453
Practice Address - Country:US
Practice Address - Phone:787-450-3756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1330156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician