| Montalvan Miro Dermatology, Llc | |
|
Carr 693 Esquina Ave. Jose Efron Doctors Health Center Dorado Clinic #24 Plaza Dorada Dorado PR 00646-4810 | |
| (787) 621-3322 | |
| Not Available |
| Full Name | Montalvan Miro Dermatology, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | Carr 693 Esquina Ave. Jose Efron, Dorado, Puerto Rico |
| Authorized Official Name and Position | Elena M Montalvan Miro (PRESIDENT) |
| Authorized Official Contact | 7874035401 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Montalvan Miro Dermatology, Llc 1511 Ave Ponce De Leon Apt 1183 San Juan PR 00909-5001 Ph: (787) 403-5401 | Montalvan Miro Dermatology, Llc Carr 693 Esquina Ave. Jose Efron Doctors Health Center Dorado Clinic #24 Plaza Dorada Dorado PR 00646-4810 Ph: (787) 621-3322 |
| NPI Number | 1659785632 |
|---|---|
| Provider Enumeration Date | 06/17/2014 |
| Last Update Date | 06/17/2014 |
| Medicare PECOS PAC ID | 9436376720 |
|---|---|
| Medicare Enrollment ID | O20140811000599 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659785632 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Elena M Montalvan Miro |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1922231919 PECOS PAC ID: 0345467635 Enrollment ID: I20140811000658 |
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