Provider Demographics
NPI:1821212424
Name:NAZARIO GUIRAU, LUIS ANTONIO (MD,GS,FABWH,FACHM)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ANTONIO
Last Name:NAZARIO GUIRAU
Suffix:
Gender:M
Credentials:MD,GS,FABWH,FACHM
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 364581
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-4581
Mailing Address - Country:US
Mailing Address - Phone:787-505-6076
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA PONCE DE LEON # 715
Practice Address - Street 2:HOSPITAL AUXILIO MUTUO
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-758-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8131208600000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC82663Medicare UPIN
PR29611Medicare ID - Type Unspecified