Provider Demographics
NPI:1154498749
Name:ALBERT, LUIS M (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:M
Last Name:ALBERT
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:PO BOX 251389
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91225
Mailing Address - Country:US
Mailing Address - Phone:818-246-2456
Mailing Address - Fax:818-507-7517
Practice Address - Street 1:801 S CHEVY CHASE DR
Practice Address - Street 2:SUITE 108
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-4431
Practice Address - Country:US
Practice Address - Phone:818-246-2456
Practice Address - Fax:818-507-7517
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA23970207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
5A16348OtherPHYS. SUPERVISOR LICENSE
A23970OtherPHYS. SUPERVISOR LICENSE
AA4313499OtherDEA CA MED BOARD
5A16348OtherPHYS. SUPERVISOR LICENSE
AA4313499OtherDEA CA MED BOARD
00A239700Medicare ID - Type Unspecified