Provider Demographics
NPI:1790346252
Name:ALVARADO THIELE, LUIS ALBERTO (PA)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ALBERTO
Last Name:ALVARADO THIELE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CALLE BALDORIOTY DE CASTRO
Mailing Address - Street 2:
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757-2613
Mailing Address - Country:US
Mailing Address - Phone:787-590-9566
Mailing Address - Fax:
Practice Address - Street 1:19 CALLE BALDORIOTY DE CASTRO
Practice Address - Street 2:
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757-2613
Practice Address - Country:US
Practice Address - Phone:787-590-9566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR228-P.A.363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant