=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942224159
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MIGUEL H CREALES M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2006
-----------------------------------------------------
Last Update Date | 04/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 92 CALLE SOL ESQUINA TORRES
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00730-3669
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-841-8855
-----------------------------------------------------
Fax | 787-841-8855
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3640 CALLE CUMBRE URB EL MONTE
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00716-4809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-975-1323
-----------------------------------------------------
Fax | 787-841-8855
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 11495
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------