Healthcare Provider Details

I. General information

NPI: 1235124587
Provider Name (Legal Business Name): EDDY A MIESES ARIZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

D3 FRONTERA AVE VILLA ANDALUCIA
RIOS PIEDRAS PR
00926
US

IV. Provider business mailing address

PO BOX 270011
SAN JUAN PR
00928-2811
US

V. Phone/Fax

Practice location:
  • Phone: 787-761-1555
  • Fax: 787-292-7260
Mailing address:
  • Phone: 787-761-1555
  • Fax: 787-292-7260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number11734
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: