Provider Demographics
NPI:1821025206
Name:GOVEO ORTIZ, LUIS JAVIER (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:JAVIER
Last Name:GOVEO ORTIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LUIS
Other - Middle Name:J
Other - Last Name:GOVEO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:425 CARR 693 PMB 103
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-310-9731
Mailing Address - Fax:787-796-4379
Practice Address - Street 1:MANATI MEDICAL CENTER
Practice Address - Street 2:CALLE HERNANDEZ CARRION URB ATENAS
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-621-3700
Practice Address - Fax:787-621-3710
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13010208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
G97369Medicare UPIN
0090129Medicare ID - Type Unspecified