Provider Demographics
NPI:1659449627
Name:VIERA-CABAN, LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:
Last Name:VIERA-CABAN
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:PO BOX 1442
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-1442
Mailing Address - Country:US
Mailing Address - Phone:787-884-0060
Mailing Address - Fax:787-812-0565
Practice Address - Street 1:TORRE MEDICA I
Practice Address - Street 2:EDIFICIO PEDRO BLANCO LUGO SUITE 214
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-4863
Practice Address - Country:US
Practice Address - Phone:787-884-0060
Practice Address - Fax:787-812-0565
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10258208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0082458Medicare ID - Type Unspecified
PRE83770Medicare UPIN