Healthcare Provider Details

I. General information

NPI: 1003951849
Provider Name (Legal Business Name): ANGEL SAN MIGUEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LA TORRE DE PLAZA LAS AMERICAS SUITE 709 F.D. ROOSVELT
SAN JUAN PR
00918
US

IV. Provider business mailing address

LA TORRE DE PLAZA LAS AMERICAS SUITE 709 F.D. ROOSVELT
SAN JUAN PR
00918
US

V. Phone/Fax

Practice location:
  • Phone: 787-764-8111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number558
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: