Provider Demographics
NPI:1568586287
Name:DELGADO MATEU, LUIS A
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:A
Last Name:DELGADO MATEU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 PALMAS INN WAY
Mailing Address - Street 2:SUITE 130 PMB 124
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-6181
Mailing Address - Country:US
Mailing Address - Phone:787-403-3770
Mailing Address - Fax:
Practice Address - Street 1:HOSP. DR. ISAACGONZALEZ MARTINEZ
Practice Address - Street 2:AVE. AMERICO MIRANDA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-763-4149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11592207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR11592OtherPRACTICE LICENSE
PR11592OtherPRACTICE LICENSE