Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 558 | PR |
NPI | 1003951849 |
---|---|
Provider Name | Angel San Miguel |
First Address | San Juan, PR 00918 |
Second Address | San Juan, PR 00918 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2007 |
Last Update Date | 08/07/2007 |