Provider Demographics
NPI:1821064346
Name:MIRO-DIAZ, ANGEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:J
Last Name:MIRO-DIAZ
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 29586
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0586
Mailing Address - Country:US
Mailing Address - Phone:787-282-3000
Mailing Address - Fax:787-282-3080
Practice Address - Street 1:369 DE DIEGO AVE
Practice Address - Street 2:TORRE SAN FRANCISCO SUITE 507
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923
Practice Address - Country:US
Practice Address - Phone:787-282-3000
Practice Address - Fax:787-767-2272
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9630207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR81914OtherTRIPLE-S
PR2723OtherPREFERRED MEDICARE CHOICE
PR9250092OtherHUMANA
PR29639OtherMCS
PR991746OtherMMM
PR29639OtherMCS
PR81914Medicare ID - Type Unspecified