Provider Demographics
NPI:1285780965
Name:PINA, JOSE ANGEL
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ANGEL
Last Name:PINA
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 11381
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-1381
Mailing Address - Country:US
Mailing Address - Phone:787-258-1230
Mailing Address - Fax:787-258-1230
Practice Address - Street 1:CALLE MARGINAL A-4
Practice Address - Street 2:URB. SAN SALVADOR
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-854-5151
Practice Address - Fax:787-854-5443
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR532152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR58255Medicare ID - Type Unspecified