Provider Demographics
NPI:1871597229
Name:MADERA, ANGEL (OD)
Entity type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:
Last Name:MADERA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 CARR 128
Mailing Address - Street 2:STE 106
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-4434
Mailing Address - Country:US
Mailing Address - Phone:787-267-7829
Mailing Address - Fax:787-267-7829
Practice Address - Street 1:550 CARR 128
Practice Address - Street 2:STE 106
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-4434
Practice Address - Country:US
Practice Address - Phone:787-267-7829
Practice Address - Fax:787-267-7829
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR545152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR03321OtherAMERICAN HEALTH
PR215111OtherPREFERRED HEALTH
PR068-660588611-068545OtherGLOBAL HEALTH PLAN
PR55379AMOtherSSS
PR7126OtherFIRST MEDICAL
PR890159OtherMMM
PR7126OtherFIRST MEDICAL