Provider Demographics
NPI:1720029317
Name:CHINEA, ANGEL R SR (MD)
Entity Type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:R
Last Name:CHINEA
Suffix:SR
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 19059
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-1059
Mailing Address - Country:US
Mailing Address - Phone:787-793-7984
Mailing Address - Fax:787-782-9000
Practice Address - Street 1:CENTRO INTERNACIONAL DE MERCADEO
Practice Address - Street 2:SUITE 306
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-793-7984
Practice Address - Fax:787-782-9000
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
PR67752084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C79710Medicare UPIN
2-7958Medicare PIN