Provider Demographics
NPI:1497852461
Name:GODREAU, LUIS GILBERTO (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:GILBERTO
Last Name:GODREAU
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:PO BOX 801054
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-1054
Mailing Address - Country:US
Mailing Address - Phone:787-984-8937
Mailing Address - Fax:787-984-8937
Practice Address - Street 1:1681 PASEO VILLA FLORES
Practice Address - Street 2:SUITE 204
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-2952
Practice Address - Country:US
Practice Address - Phone:787-844-3737
Practice Address - Fax:787-290-5959
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13592207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7660028OtherPROVIDER HUMANA
PR8-4082OtherPROVIDER SSS
PR8-4082OtherPROVIDER SSS
PRH-45014Medicare UPIN