Basic Information
| Provider Information | |||||||||
| NPI: | 1659447514 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MIRANADA GALLOZA | ||||||||
| FirstName: | MIRELIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | HC 3 BOX 31531 | ||||||||
| Address2: | |||||||||
| City: | AGUADA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006029757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872382923 | ||||||||
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| Practice Location | |||||||||
| Address1: | 550 CALLE CONCEPCION VERA AYALA | ||||||||
| Address2: | HOSPITAL SAN CARLOS BORROMEO | ||||||||
| City: | MOCA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006760068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878778000 | ||||||||
| FaxNumber: | 7875517066 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2006 | ||||||||
| LastUpdateDate: | 09/13/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 16589 | PR | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.