Provider Demographics
NPI:1235502261
Name:DOCTOR A TU LADO
Entity Type:Organization
Organization Name:DOCTOR A TU LADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:F
Authorized Official - Last Name:ROSA DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-460-4609
Mailing Address - Street 1:PO BOX 1254
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-1254
Mailing Address - Country:US
Mailing Address - Phone:787-885-8080
Mailing Address - Fax:787-885-8081
Practice Address - Street 1:190 AVE LAURO PINERO
Practice Address - Street 2:
Practice Address - City:CEIBA
Practice Address - State:PR
Practice Address - Zip Code:00735-2732
Practice Address - Country:US
Practice Address - Phone:787-885-8080
Practice Address - Fax:787-885-8081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13318171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty