# MONTALVAN MIRO DERMATOLOGY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659785632
- **Authorized official:** DR. ELENA M MONTALVAN MIRO M.D. (PRESIDENT)
- **Authorized official phone:** (787) 403-5401

## Contact information

- **Practice address:** CARR 693 ESQUINA AVE. JOSE EFRON, DOCTORS HEALTH CENTER DORADO CLINIC \#24 PLAZA DORADA, DORADO, PR 00646-4810
- **Practice address phone:** (787) 621-3322
- **Mailing address:** 1511 AVE PONCE DE LEON APT 1183, SAN JUAN, PR 00909-5001
- **Mailing address phone:** (787) 403-5401

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/17/2014
- **Last updated:** 06/17/2014