Provider Demographics
NPI:1336255926
Name:RESTO, LUIS ALBERTO (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ALBERTO
Last Name:RESTO
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 1:24 CALLE GLORIA
Mailing Address - Street 2:MANS EL PARAISO
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-9492
Mailing Address - Country:US
Mailing Address - Phone:787-704-1434
Mailing Address - Fax:
Practice Address - Street 1:#21 CALLE IGNACIO MORALES PRIMER NIVEL
Practice Address - Street 2:
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719
Practice Address - Country:US
Practice Address - Phone:787-869-3773
Practice Address - Fax:787-869-3773
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9877207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E08573Medicare UPIN
E08573Medicare UPIN