Provider Demographics
NPI:1619405826
Name:CADIZ, LUIS MIGUEL JR (MD)
Entity Type:Individual
Prefix:PROF
First Name:LUIS
Middle Name:MIGUEL
Last Name:CADIZ
Suffix:JR
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 1:222 CALLE SAN FELIPE
Mailing Address - Street 2:URB LIRIOS CALA
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777
Mailing Address - Country:US
Mailing Address - Phone:787-404-5826
Mailing Address - Fax:
Practice Address - Street 1:2100 CALLE TURQUESA BUCARE
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00970-3563
Practice Address - Country:US
Practice Address - Phone:787-404-5933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5770103TP2701X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy