Healthcare Provider Details

I. General information

NPI: 1609171214
Provider Name (Legal Business Name): MR. LUIS D LLINS MAZORRA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URBANIZACION EL VEDADO. HATO REY BONAFOUX # 424
SAN JUAN PR
00918-3043
US

IV. Provider business mailing address

424 CALLE BONAFOUX URBANIZACION EL VEDADO. HATO REY
SAN JUAN PR
00918-3043
US

V. Phone/Fax

Practice location:
  • Phone: 786-306-7724
  • Fax:
Mailing address:
  • Phone: 786-306-7724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number34046
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: