Healthcare Provider Details

I. General information

NPI: 1790346252
Provider Name (Legal Business Name): LUIS ALBERTO ALVARADO THIELE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date: 07/13/2026
Reactivation Date: 07/30/2026

III. Provider practice location address

19 CALLE BALDORIOTY DE CASTRO
SANTA ISABEL PR
00757-2613
US

IV. Provider business mailing address

HC 7 BOX 32126
JUANA DIAZ PR
00795-9205
US

V. Phone/Fax

Practice location:
  • Phone: 787-590-9566
  • Fax:
Mailing address:
  • Phone: 787-590-9566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25122
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: