Healthcare Provider Details

I. General information

NPI: 1366456436
Provider Name (Legal Business Name): MIGUEL ANGEL OQUENDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MIGUEL A OQUENDO-GRAULAU MD

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CALLE CASIA
SAN JUAN PR
00921-3200
US

IV. Provider business mailing address

R4 CALLE PALMA REAL URBANIZACION SANTA CLARA
GUAYNABO PR
00969-6820
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-7582
  • Fax:
Mailing address:
  • Phone: 787-272-5192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number8399
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: