Provider Demographics
NPI:1508089269
Name:SIERRA, LUIS ALBERTO (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ALBERTO
Last Name:SIERRA
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 1:1479 AVE ASHFORD APT 1817
Mailing Address - Street 2:AVE ASHFORD 1479
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1547
Mailing Address - Country:US
Mailing Address - Phone:939-639-2610
Mailing Address - Fax:
Practice Address - Street 1:1479 AVE ASHFORD APT 1817
Practice Address - Street 2:AVE ASHFORD 1479
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1547
Practice Address - Country:US
Practice Address - Phone:939-639-2610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14315208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR14315OtherLIC ESTATAL