Provider Demographics
NPI:1679533723
Name:GERENA, LUIS
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:
Last Name:GERENA
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:PO BOX 800997
Mailing Address - Street 2:TORRE SAN CRISTOBAL SUIT 310
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-0997
Mailing Address - Country:US
Mailing Address - Phone:787-840-2747
Mailing Address - Fax:787-840-2747
Practice Address - Street 1:TORRE SAN CRISTOBAL PR 506 KM. 1.0. TERCER PISO
Practice Address - Street 2:SUIT 310 C/O
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780-0997
Practice Address - Country:US
Practice Address - Phone:787-840-2747
Practice Address - Fax:787-840-2747
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5716225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2-7599OtherTRIPLE S
PR2501929OtherACAA
PR600257OtherMEDICARE MUCHO MAS
PR223049OtherPREFERED HEALTH
PR4043OtherPREFERED MEDICARE CHOICE
PR9130001OtherHUMANA INSURANCE
PR4043OtherPREFERED MEDICARE CHOICE
PR0027599Medicare ID - Type Unspecified