Provider Demographics
NPI:1346212388
Name:LANDESTOY, LUIS E (MD)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:E
Last Name:LANDESTOY
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:A L 5 VIA ELENA
Mailing Address - Street 2:VILLA FONTANA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983-3901
Mailing Address - Country:US
Mailing Address - Phone:787-762-9424
Mailing Address - Fax:
Practice Address - Street 1:AL5 VIA ELENA
Practice Address - Street 2:VILLA FONTANA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983-3901
Practice Address - Country:US
Practice Address - Phone:787-762-9424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X
PR7570208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR82107Medicare UPIN
E57434Medicare UPIN