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General NPI Number Information
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NPI Number | 1679793905
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Entity Type | Individual
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Provider Name | LUIS E MORA-ANTONGIORGI OD
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Gender | Male
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Dates
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Enumeration Date | 04/27/2007
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Last Update Date | 01/05/2022
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Provider Practice Location Address
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Address Line | 525 AVE ROOSEVELT PLAZA LAS AMERICAS LENSCRAFTERS 0474
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City | SAN JUAN
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State | PR
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Zip | 00918
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Country | US
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Telephone | 787-753-6431
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Fax | 787-753-0852
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Provider Business Mailing Address
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Address Line | 576 AVE ARTERIAL B APT 2309
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City | SAN JUAN
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State | PR
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Zip | 00918
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Country | US
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Telephone | 787-892-1218
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Fax | 787-892-7480
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 403-0029
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License Number State | PR
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