Healthcare Provider Details

I. General information

NPI: 1376464891
Provider Name (Legal Business Name): LUIS ALEJANDRO MISLA GONZALEZ LDO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 CALLE 10 SW
SAN JUAN PR
00921-1527
US

IV. Provider business mailing address

1528 CALLE 10 SW
SAN JUAN PR
00921-1527
US

V. Phone/Fax

Practice location:
  • Phone: 787-941-8089
  • Fax:
Mailing address:
  • Phone: 787-941-8089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number1611
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: