=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174523732
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | OSVALDO DARIO BAZIL-MIESES MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2005
-----------------------------------------------------
Last Update Date | 05/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | URB. VISTA VERDE #6 CALLE CORAL
-----------------------------------------------------
City | MAYAGUEZ
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00682-2508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-329-7814
-----------------------------------------------------
Fax | 939-935-9006
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | URB VISTA VERDE #6 CALLE CORAL
-----------------------------------------------------
City | MAYAGUEZ
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00682-2508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-329-7814
-----------------------------------------------------
Fax | 939-935-9006
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | K3985
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 8215
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------