Provider Demographics
NPI:1114493152
Name:LUQUILLO MEDICAL LLC
Entity Type:Organization
Organization Name:LUQUILLO MEDICAL LLC
Other - Org Name:LUQUILLO MEDICAL INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:A
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-513-7292
Mailing Address - Street 1:PO BOX 77
Mailing Address - Street 2:
Mailing Address - City:LUQUILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00773-0077
Mailing Address - Country:US
Mailing Address - Phone:787-534-8384
Mailing Address - Fax:787-534-8385
Practice Address - Street 1:171 CALLE CPL FELICIANO RIVERA
Practice Address - Street 2:
Practice Address - City:LUQUILLO
Practice Address - State:PR
Practice Address - Zip Code:00773-2147
Practice Address - Country:US
Practice Address - Phone:787-534-8384
Practice Address - Fax:787-534-8385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-17
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty