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General NPI Number Information
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NPI Number | 1669673927
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Entity Type | Individual
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Provider Name | LUIS ALBERTO BERRIOS M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 696 MUCKERMAN RD
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City | BENNETTSVILLE
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State | SC
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Zip | 29512-6195
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Country | US
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Telephone | 843-454-8200
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Fax | 843-454-8324
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Provider Business Mailing Address
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Address Line | 3888 WEST POINTE DR
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City | FLORENCE
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State | SC
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Zip | 29501-8552
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Country | US
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Telephone | 843-664-1849
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 12582
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License Number State | PR
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