Healthcare Provider Details

I. General information

NPI: 1487669180
Provider Name (Legal Business Name): LUIS A NAVEDO PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: LUIS A NAVEDO NAVEDO

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AVE LAGUNA LAGUNA GARDENS I, APT 3J
CAROLINA PR
00979-6401
US

IV. Provider business mailing address

1 AVE LAGUNA
CAROLINA PR
00979-6525
US

V. Phone/Fax

Practice location:
  • Phone: 787-667-1085
  • Fax:
Mailing address:
  • Phone: 939-227-6732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001504
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: