MEDICARE: LUIS J. FORASTIERI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	13433	PR
2	2084N0600X	Clinical Neurophysiology Physician	13433	PR

General Provider Information

NPI Number	:	1902808553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS J. FORASTIERI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 995
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00726-0995
Country	:	US
Telephone Number	:	787-704-3435
Fax Number	:	787-704-3440

Provider Business Practice Location Address
First Line	:	1 CALLE NAZARIO
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00725-2683
Country	:	US
Telephone Number	:	787-704-3435
Fax Number	:	787-704-3440

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	09/09/2010

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