Healthcare Provider Details

I. General information

NPI: 1205899853
Provider Name (Legal Business Name): LUIS J TORRUELLA MD, FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 AVE TITO CASTRO SUITE 822 TORRE MEDICA SAN LUCAS
PONCE PR
00716-4725
US

IV. Provider business mailing address

909 AVE TITO CASTRO SUITE 822 TORRE MEDICA SAN LUCAS
PONCE PR
00716-4725
US

V. Phone/Fax

Practice location:
  • Phone: 787-284-0804
  • Fax: 787-284-0512
Mailing address:
  • Phone: 787-284-0804
  • Fax: 787-284-0512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number10536
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: