Provider Demographics
NPI:1205093499
Name:DR.LUIS FELIPE GUZMAN RUIZ; CSP
Entity type:Organization
Organization Name:DR.LUIS FELIPE GUZMAN RUIZ; CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICO
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:FELIPE
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-280-0982
Mailing Address - Street 1:P O BOX 135
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00678
Mailing Address - Country:UM
Mailing Address - Phone:787-280-0982
Mailing Address - Fax:787-280-0982
Practice Address - Street 1:AVE ARCADIO ESTRADA # 4100
Practice Address - Street 2:SAN SEBASTIN OFFICE BUILDING
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-1579
Practice Address - Country:US
Practice Address - Phone:787-280-0982
Practice Address - Fax:787-280-0982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10033302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0082640Medicare PIN
PRF18-900Medicare UPIN