Provider Demographics
NPI:1578387866
Name:EMANUELLI MIRANDA, CRISTALY (MD)
Entity type:Individual
Prefix:
First Name:CRISTALY
Middle Name:
Last Name:EMANUELLI MIRANDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CRISTALY
Other - Middle Name:
Other - Last Name:EMANUELLI MIRANDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:909 AVE TITO CASTRO
Mailing Address - Street 2:STE 721 LA TORRE MEDICA SAN LUCAS
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-4722
Mailing Address - Country:US
Mailing Address - Phone:787-651-0312
Mailing Address - Fax:
Practice Address - Street 1:909 AVE TITO CASTRO
Practice Address - Street 2:STE 721 LA TORRE MEDICA SAN LUCAS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4722
Practice Address - Country:US
Practice Address - Phone:787-651-0312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-13
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004626235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist