Healthcare Provider Details

I. General information

NPI: 1659449627
Provider Name (Legal Business Name): LUIS VIERA-CABAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 03/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TORRE MEDICA I EDIFICIO PEDRO BLANCO LUGO SUITE 214
MANATI PR
00674-4863
US

IV. Provider business mailing address

PO BOX 1442
MANATI PR
00674-1442
US

V. Phone/Fax

Practice location:
  • Phone: 787-884-0060
  • Fax: 787-812-0565
Mailing address:
  • Phone: 787-884-0060
  • Fax: 787-812-0565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number10258
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: