Healthcare Provider Details

I. General information

NPI: 1023741014
Provider Name (Legal Business Name): LUIS ROBERTO BERRIOS PAGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOPU BO MONACILLOS CARR #22 CENTRO MEDICO
SAN JUAN PR
00935-0001
US

IV. Provider business mailing address

8030 WADI APT B-202
WHITE LAKE MI
48386-1374
US

V. Phone/Fax

Practice location:
  • Phone: 787-474-0333
  • Fax:
Mailing address:
  • Phone: 787-598-3326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4351054790
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: