Provider Demographics
NPI:1801245675
Name:PUCHI, LUIS ALBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ALBERTO
Last Name:PUCHI
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 1:10401 SW 53RD ST
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-5607
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10401 SW 53RD ST
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33328-5607
Practice Address - Country:US
Practice Address - Phone:917-387-6601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-12
Last Update Date:2025-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR4457207P00000X
WV28929207P00000X
NC2019-01568207P00000X
GA83357207P00000X
VA0101266443207P00000X
OH35.138120207P00000X
390200000X
FLME152136207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program