Provider Demographics
NPI:1326181462
Name:MARCIAL, LUISA VANESSA (MD)
Entity Type:Individual
Prefix:DR
First Name:LUISA
Middle Name:VANESSA
Last Name:MARCIAL
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Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 1589
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-1589
Mailing Address - Country:US
Mailing Address - Phone:787-966-7500
Mailing Address - Fax:787-966-7505
Practice Address - Street 1:EXT. HNAS DAVILA MARGINAL CARR. PR #2
Practice Address - Street 2:EDIFICIO 1955 SUITE G-1
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-966-7500
Practice Address - Fax:787-966-7505
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2015-03-12
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Provider Licenses
StateLicense IDTaxonomies
PR82812085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PREQ590ZMedicare PIN