Provider Demographics
NPI:1578766887
Name:CONTRERAS, LUIS FIDEL
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:FIDEL
Last Name:CONTRERAS
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 1:3208 ROSEMEAD BLVD
Mailing Address - Street 2:100
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2830
Mailing Address - Country:US
Mailing Address - Phone:626-227-7001
Mailing Address - Fax:626-227-7002
Practice Address - Street 1:3208 ROSEMEAD BLVD
Practice Address - Street 2:100
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2830
Practice Address - Country:US
Practice Address - Phone:626-227-7001
Practice Address - Fax:626-227-7002
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator