Provider Demographics
NPI:1205990025
Name:OFICINA MEDICA DR. LUIS J. SUAU, CSP
Entity type:Organization
Organization Name:OFICINA MEDICA DR. LUIS J. SUAU, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:SUAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-833-0610
Mailing Address - Street 1:PO BOX 3228
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-3228
Mailing Address - Country:US
Mailing Address - Phone:787-833-0610
Mailing Address - Fax:787-834-4265
Practice Address - Street 1:55 CALLE MEDITACION STE 2A
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4848
Practice Address - Country:US
Practice Address - Phone:787-833-0610
Practice Address - Fax:787-834-4265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR311453261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRBY985AMedicare PIN
PR0095197Medicare PIN
PRC78113Medicare UPIN