Provider Demographics
NPI:1881689164
Name:CANINO, ANGEL L (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:L
Last Name:CANINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1590
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-1590
Mailing Address - Country:US
Mailing Address - Phone:787-896-1887
Mailing Address - Fax:787-896-1887
Practice Address - Street 1:23 MENDEZ LICIAGA ST
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:787-896-1887
Practice Address - Fax:787-896-1887
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4383174400000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC83861Medicare UPIN