Healthcare Provider Details

I. General information

NPI: 1427036045
Provider Name (Legal Business Name): LUIS A LLANOS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE 65 INFANTERIA K-3.4 BO SABANA LLANA
SAN JUAN PR
00924
US

IV. Provider business mailing address

TERRALINDA ESTATES #39
TRUJILLO ALTO PR
00976
US

V. Phone/Fax

Practice location:
  • Phone: 787-767-7676
  • Fax:
Mailing address:
  • Phone: 787-767-7676
  • Fax: 787-764-0094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number18564
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: