Healthcare Provider Details

I. General information

NPI: 1164403077
Provider Name (Legal Business Name): LUIS A SANMIGUEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 07/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR.#3 KM8.4 PASEO DEL PRADO SC SUITE 200
CAROLINA PR
00987
US

IV. Provider business mailing address

PMB 208 POBOX 2500
TRUJILLO ALTO PR
00977-2500
US

V. Phone/Fax

Practice location:
  • Phone: 787-710-2532
  • Fax: 787-750-2830
Mailing address:
  • Phone: 787-710-2532
  • Fax: 787-750-2830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number11721
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: