Provider Demographics
NPI:1205923505
Name:FORTI ISALES, LUIS RAUL (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:RAUL
Last Name:FORTI ISALES
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PMB 136
Mailing Address - Street 2:3071 AVE. ALEJANDRINO
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-269-8611
Mailing Address - Fax:787-778-1711
Practice Address - Street 1:EDIFICIO MEDICO SANTA CRUZ # 73
Practice Address - Street 2:SUITE 410
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960
Practice Address - Country:US
Practice Address - Phone:787-269-8611
Practice Address - Fax:787-778-1711
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2021-01-20
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Provider Licenses
StateLicense IDTaxonomies
PR10315207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF47586Medicare UPIN
PR0082870Medicare ID - Type Unspecified