Healthcare Provider Details

I. General information

NPI: 1437636883
Provider Name (Legal Business Name): LUIS CAJINA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2018
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 2ND AVE FL 3
BROOKLYN NY
11215-2711
US

IV. Provider business mailing address

15 2ND AVE FL 3
BROOKLYN NY
11215-2711
US

V. Phone/Fax

Practice location:
  • Phone: 718-514-6007
  • Fax:
Mailing address:
  • Phone: 718-514-6007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9190560
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number805865
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF405161-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: