Provider Demographics
NPI:1144478249
Name:MUNOZ MIRABAL, ANGEL R (MD)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:R
Last Name:MUNOZ MIRABAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5150 LINTON BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6528
Mailing Address - Country:US
Mailing Address - Phone:561-638-7577
Mailing Address - Fax:561-638-9322
Practice Address - Street 1:3200 VINE ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-2213
Practice Address - Country:US
Practice Address - Phone:513-861-3100
Practice Address - Fax:513-475-6534
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME130345207ZC0500X
KY48584207ZP0102X
PR17856207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Multi-Specialty
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY48584OtherKENTUCKY MEDICAL LICENSE
PR17856OtherNO