Healthcare Provider Details

I. General information

NPI: 1194787036
Provider Name (Legal Business Name): DR. LUIS A WALTERS MARQUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 08/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE DE HOSTOS #511 BALDRICH
SAN JUAN PR
00918
US

IV. Provider business mailing address

511 AVE DE HOSTOS BALDRICH
SAN JUAN PR
00918
US

V. Phone/Fax

Practice location:
  • Phone: 787-250-6493
  • Fax: 787-250-6493
Mailing address:
  • Phone: 787-250-6493
  • Fax: 787-250-6493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0028
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: