Provider Demographics
NPI:1376559179
Name:BOERAS PUPO, LUIS CESAR (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:CESAR
Last Name:BOERAS PUPO
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:FELISA RINCON DE GAUTIER AVE. # 381
Mailing Address - Street 2:PASEOMONTE. APTO 1403
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-755-1696
Mailing Address - Fax:
Practice Address - Street 1:400 AVE DOMENECH
Practice Address - Street 2:SUITE 602-C LAS AMERICAS PROF CENTER
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3710
Practice Address - Country:US
Practice Address - Phone:787-764-0356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12910174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH81956Medicare UPIN
PR0020242Medicare ID - Type Unspecified