Provider Demographics
NPI:1518928480
Name:YSLAND EUSEBIO, LUISA (MD)
Entity Type:Individual
Prefix:DR
First Name:LUISA
Middle Name:
Last Name:YSLAND EUSEBIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:LUISA
Other - Middle Name:
Other - Last Name:YSLAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1281 CALLE 13
Mailing Address - Street 2:MONTECARLO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-5236
Mailing Address - Country:US
Mailing Address - Phone:787-934-5035
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 22 BARRIO MONACILLOS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00922
Practice Address - Country:US
Practice Address - Phone:787-750-0667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10790208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0082982Medicare ID - Type Unspecified
PRF50396Medicare UPIN