Healthcare Provider Details

I. General information

NPI: 1205990025
Provider Name (Legal Business Name): OFICINA MEDICA DR. LUIS J. SUAU, CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 CALLE MEDITACION STE 2A
MAYAGUEZ PR
00680-4848
US

IV. Provider business mailing address

PO BOX 3228
MAYAGUEZ PR
00681-3228
US

V. Phone/Fax

Practice location:
  • Phone: 787-833-0610
  • Fax: 787-834-4265
Mailing address:
  • Phone: 787-833-0610
  • Fax: 787-834-4265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number311453
License Number StatePR

VIII. Authorized Official

Name: DR. LUIS J SUAU
Title or Position: OWNER
Credential: M.D
Phone: 787-833-0610