Healthcare Provider Details

I. General information

NPI: 1831150614
Provider Name (Legal Business Name): LUIS BAERGA-VARELA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 AVE ANDALUCIA
SAN JUAN PR
00920-5311
US

IV. Provider business mailing address

2312 CALLE TENIENTE RIVERA URB SANTA TEREITA
SAN JUAN PR
00913-4530
US

V. Phone/Fax

Practice location:
  • Phone: 787-461-1780
  • Fax:
Mailing address:
  • Phone: 787-957-5553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number15364
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number15364
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: