Provider Demographics
NPI:1235124587
Name:MIESES ARIZA, EDDY A (MD)
Entity Type:Individual
Prefix:DR
First Name:EDDY
Middle Name:A
Last Name:MIESES ARIZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 270011
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928-2811
Mailing Address - Country:US
Mailing Address - Phone:787-761-1555
Mailing Address - Fax:787-292-7260
Practice Address - Street 1:D3 FRONTERA AVE VILLA ANDALUCIA
Practice Address - Street 2:
Practice Address - City:RIOS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-761-1555
Practice Address - Fax:787-292-7260
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11734207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
220174OtherUTE
601591OtherMEDICARE MMM
9590091OtherUMANA
060154OtherBASUR
88493MIOtherTRIPLE S
2346OtherPREFERRED MEDICARE CHOICE
PR88033Medicare ID - Type Unspecified
601591OtherMEDICARE MMM