1235124587 NPI number — DR. EDDY A MIESES ARIZA MD

Table of content: DR. EDDY A MIESES ARIZA MD (NPI 1235124587)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235124587 NPI number — DR. EDDY A MIESES ARIZA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIESES ARIZA
Provider First Name:
EDDY
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235124587
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 270011
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00928-2811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-761-1555
Provider Business Mailing Address Fax Number:
787-292-7260

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
D3 FRONTERA AVE VILLA ANDALUCIA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIOS PIEDRAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-761-1555
Provider Business Practice Location Address Fax Number:
787-292-7260
Provider Enumeration Date:
09/13/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RI0011X , with the licence number:  11734 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 220174 . This is a "UTE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 601591 . This is a "MEDICARE MMM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9590091 . This is a "UMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 060154 . This is a "BASUR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 88493MI . This is a "TRIPLE S" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2346 . This is a "PREFERRED MEDICARE CHOICE" identifier . This identifiers is of the category "OTHER".