Healthcare Provider Details

I. General information

NPI: 1043586563
Provider Name (Legal Business Name): LUIS F SANCHEZ-LONGO MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL DEL MAESTRO 505 SERGIO CUEVAS, PRIMER NIVEL
SAN JUAN PR
00918
US

IV. Provider business mailing address

PO BOX 190309
SAN JUAN PR
00919-0309
US

V. Phone/Fax

Practice location:
  • Phone: 787-244-7244
  • Fax:
Mailing address:
  • Phone: 787-244-7244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1931
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1931
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: