Healthcare Provider Details

I. General information

NPI: 1811065709
Provider Name (Legal Business Name): ORLANDO LUCIANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STREET 311 KILOMETER 0.2
CABO ROJO PR
00623
US

IV. Provider business mailing address

PO BOX 1148
CABO ROJO PR
00623-1148
US

V. Phone/Fax

Practice location:
  • Phone: 787-255-3843
  • Fax: 787-255-3843
Mailing address:
  • Phone: 787-255-3843
  • Fax: 787-255-3843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9797
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: