Healthcare Provider Details

I. General information

NPI: 1235137126
Provider Name (Legal Business Name): ANGEL VIERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 11/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 KING'S COURT APT 1002
SAN JUAN PR
00911-1159
US

IV. Provider business mailing address

59 KING'S COURT APT 1002
SAN JUAN PR
00911-1159
US

V. Phone/Fax

Practice location:
  • Phone: 787-396-1022
  • Fax:
Mailing address:
  • Phone: 787-396-1022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number08279
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: