Provider Demographics
NPI:1164403077
Name:SANMIGUEL, LUIS A (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:A
Last Name:SANMIGUEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PMB 208 POBOX 2500
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-2500
Mailing Address - Country:US
Mailing Address - Phone:787-710-2532
Mailing Address - Fax:787-750-2830
Practice Address - Street 1:CARR.#3 KM8.4 PASEO DEL PRADO SC
Practice Address - Street 2:SUITE 200
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-710-2532
Practice Address - Fax:787-750-2830
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR11721207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG42496Medicare UPIN