Healthcare Provider Details

I. General information

NPI: 1295974921
Provider Name (Legal Business Name): LUIS J LABOY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2009
Last Update Date: 02/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 AVE DE DIEGO SUITE 105
SAN JUAN PR
00927-6372
US

IV. Provider business mailing address

PO BOX 372571
CAYEY PR
00737-2571
US

V. Phone/Fax

Practice location:
  • Phone: 787-754-8500
  • Fax:
Mailing address:
  • Phone: 787-238-5152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberOO0642
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: