Provider Demographics
NPI:1457107484
Name:ENAMORADO, MAYRALIS (MD)
Entity type:Individual
Prefix:
First Name:MAYRALIS
Middle Name:
Last Name:ENAMORADO
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:PO BOX 370884
Mailing Address - Street 2:CAYEY
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-0884
Mailing Address - Country:US
Mailing Address - Phone:939-269-4497
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 370884
Practice Address - Street 2:CAYEY
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00737-0884
Practice Address - Country:US
Practice Address - Phone:939-269-4497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23776208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice