Healthcare Provider Details

I. General information

NPI: 1033247218
Provider Name (Legal Business Name): LUIS N OLMEDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STREET 3 S-13 VILLAS DE PARANA
SAN JUAN PR
00926
US

IV. Provider business mailing address

VILLAS DE PARANA STREET 3 S-3 #13
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-667-0411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number12268
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number12268
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number12268
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code209800000X
TaxonomyLegal Medicine (M.D./D.O.) Physician
License Number12268
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: