Healthcare Provider Details

I. General information

NPI: 1932323250
Provider Name (Legal Business Name): LUIS ALBERTO SOCARRAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 05/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

672 SW PRIMA VISTA BLVD SUITE 101
PORT ST LUCIE FL
34983-1820
US

IV. Provider business mailing address

PO BOX 69
JUPITER FL
33468-0069
US

V. Phone/Fax

Practice location:
  • Phone: 772-905-2555
  • Fax: 561-766-1210
Mailing address:
  • Phone: 561-766-1200
  • Fax: 561-932-0997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME32265
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME32265
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: