Provider Demographics
NPI:1437439635
Name:ALICEA, ANGEL GABRIEL
Entity type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:GABRIEL
Last Name:ALICEA
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:HC 73 BOX 4338
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-9135
Mailing Address - Country:US
Mailing Address - Phone:787-627-0363
Mailing Address - Fax:
Practice Address - Street 1:HC 73 BOX 4338
Practice Address - Street 2:
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719-9135
Practice Address - Country:US
Practice Address - Phone:787-627-0363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide