=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790780914
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUIS ROBERTO CANAS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2005
-----------------------------------------------------
Last Update Date | 09/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 38C CALLE 1 VILLA ROSALES
-----------------------------------------------------
City | AIBONITO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-735-7859
-----------------------------------------------------
Fax | 787-954-7501
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2000
-----------------------------------------------------
City | AIBONITO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00705-2000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-638-0246
-----------------------------------------------------
Fax | 787-735-2268
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 5047
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------