Provider Demographics
NPI:1386475176
Name:MIRAGLIA, MIRTHA JACQUELINE (MD)
Entity type:Individual
Prefix:
First Name:MIRTHA
Middle Name:JACQUELINE
Last Name:MIRAGLIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 AVE JOSE DE DIEGO STE 103
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-4586
Mailing Address - Country:US
Mailing Address - Phone:305-803-1759
Mailing Address - Fax:
Practice Address - Street 1:312 AVE JOSE DE DIEGO STE 103
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4586
Practice Address - Country:US
Practice Address - Phone:305-803-1759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12372207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine