Provider Demographics
NPI:1295794014
Name:AMBERT, LUIS (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:
Last Name:AMBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COND EL BOSQUE APT 1608
Mailing Address - Street 2:13 B CAMINO LOS BAEZ
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00965
Mailing Address - Country:US
Mailing Address - Phone:787-781-1005
Mailing Address - Fax:787-273-6510
Practice Address - Street 1:COND EL BOSQUE APT 1608
Practice Address - Street 2:13 B CAMINO LOS BAEZ
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00965
Practice Address - Country:US
Practice Address - Phone:787-781-1005
Practice Address - Fax:787-273-6510
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12899208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0022435Medicare ID - Type Unspecified
PRH94667Medicare UPIN