Provider Demographics
NPI:1659590917
Name:NOVOA, LUIS RAFAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:RAFAEL
Last Name:NOVOA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:AVE LAS CUMBRES #199 KM 1.2
Mailing Address - Street 2:PROFESSIONAL HOSPITAL
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-708-6560
Mailing Address - Fax:
Practice Address - Street 1:100 GRAN PASEOS BOULEVARD
Practice Address - Street 2:SUITE 112-178
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-653-0550
Practice Address - Fax:787-704-4033
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR12210207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0088906Medicare ID - Type Unspecified
PRG06614Medicare UPIN