Healthcare Provider Details

I. General information

NPI: 1114493152
Provider Name (Legal Business Name): LUQUILLO MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2018
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 CALLE CPL FELICIANO RIVERA
LUQUILLO PR
00773-2147
US

IV. Provider business mailing address

PO BOX 77
LUQUILLO PR
00773-0077
US

V. Phone/Fax

Practice location:
  • Phone: 787-534-8384
  • Fax: 787-534-8385
Mailing address:
  • Phone: 787-534-8384
  • Fax: 787-534-8385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. FRANK A GREGORY
Title or Position: PRESIDENT
Credential: MD
Phone: 787-513-7292