Provider Demographics
NPI:1093704546
Name:FUENTES, LUIS ALBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ALBERTO
Last Name:FUENTES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:A3 CALLE CORAL
Mailing Address - Street 2:GURABO
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-5108
Mailing Address - Country:US
Mailing Address - Phone:787-743-5941
Mailing Address - Fax:787-743-5941
Practice Address - Street 1:HOSPITAL CRISTO REDENTOR
Practice Address - Street 2:GUAYAMA
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00785
Practice Address - Country:US
Practice Address - Phone:787-864-4300
Practice Address - Fax:787-864-1070
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6605146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR27655Medicare ID - Type Unspecified