Healthcare Provider Details

I. General information

NPI: 1790780914
Provider Name (Legal Business Name): LUIS ROBERTO CANAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 09/10/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38C CALLE 1 VILLA ROSALES
AIBONITO PR
00705
US

IV. Provider business mailing address

PO BOX 2000
AIBONITO PR
00705-2000
US

V. Phone/Fax

Practice location:
  • Phone: 787-735-7859
  • Fax: 787-954-7501
Mailing address:
  • Phone: 787-638-0246
  • Fax: 787-735-2268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5047
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: