Healthcare Provider Details

I. General information

NPI: 1225031396
Provider Name (Legal Business Name): LUIS ANTONIO ACABA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 AVE PONCE DE LEON STE 408
SAN JUAN PR
00917-5025
US

IV. Provider business mailing address

PO BOX 11965
SAN JUAN PR
00922-1965
US

V. Phone/Fax

Practice location:
  • Phone: 787-763-1788
  • Fax: 787-756-7853
Mailing address:
  • Phone: 787-763-1788
  • Fax: 787-756-7853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number8811
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: