Healthcare Provider Details

I. General information

NPI: 1164180832
Provider Name (Legal Business Name): LUIS ANTONIO CASIANO GUIO PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2021
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 153, KM 13.7 COAMO PLAZA SHOPPING CENTER
COAMO PR
00769
US

IV. Provider business mailing address

3301 AVE EMILIO FAGOT
PONCE PR
00730-4627
US

V. Phone/Fax

Practice location:
  • Phone: 787-704-0705
  • Fax:
Mailing address:
  • Phone: 787-530-3723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7134
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: