MEDICARE: MR. LUIS D LLINS MAZORRA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	34046	PR

General Provider Information

NPI Number	:	1609171214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LUIS D LLINS MAZORRA

Provider Business Mailing Address
First Line	:	424 CALLE BONAFOUX
Second Line	:	URBANIZACION EL VEDADO. HATO REY
City	:	SAN JUAN
State	:	PR
Zip	:	00918-3043
Country	:	US
Telephone Number	:	786-306-7724
Fax Number	:

Provider Business Practice Location Address
First Line	:	URBANIZACION EL VEDADO. HATO REY
Second Line	:	BONAFOUX # 424
City	:	SAN JUAN
State	:	PR
Zip	:	00918-3043
Country	:	US
Telephone Number	:	786-306-7724
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2011
Last Update Date	:	01/13/2011

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