Provider Demographics
NPI:1669559803
Name:COMULADA, ANGEL LUIS
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:LUIS
Last Name:COMULADA
Suffix:
Gender:M
Credentials:
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 52192
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-2192
Mailing Address - Country:US
Mailing Address - Phone:787-269-6590
Mailing Address - Fax:787-269-6599
Practice Address - Street 1:CALLE MANUEL F. ROSSI ESQ ISABEL II
Practice Address - Street 2:BAYAMON HEALTH CENTER SEGUNDO PISO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-269-6590
Practice Address - Fax:787-269-6599
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12569207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH82027Medicare UPIN