Provider Demographics
NPI:1649317298
Name:FAURA CLAVELL, LUIS ENRIQUE (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ENRIQUE
Last Name:FAURA CLAVELL
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:SUITE 308
Mailing Address - Street 2:CAPARRA GALLERY
Mailing Address - City:GAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966
Mailing Address - Country:US
Mailing Address - Phone:787-273-1525
Mailing Address - Fax:787-781-9805
Practice Address - Street 1:SUITE 308
Practice Address - Street 2:CAPARRA GALLERY
Practice Address - City:GAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966
Practice Address - Country:US
Practice Address - Phone:787-273-1525
Practice Address - Fax:787-781-9805
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7058225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR660617328Medicare ID - Type Unspecified
PRC78251Medicare UPIN