1679533723 NPI number — DR. LUIS GERENA

Table of content: DR. LUIS GERENA (NPI 1679533723)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679533723 NPI number — DR. LUIS GERENA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GERENA
Provider First Name:
LUIS
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679533723
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 800997
Provider Second Line Business Mailing Address:
TORRE SAN CRISTOBAL SUIT 310
Provider Business Mailing Address City Name:
COTO LAUREL
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00780-0997
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-840-2747
Provider Business Mailing Address Fax Number:
787-840-2747

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
TORRE SAN CRISTOBAL PR 506 KM. 1.0. TERCER PISO
Provider Second Line Business Practice Location Address:
SUIT 310 C/O
Provider Business Practice Location Address City Name:
COTO LAUREL
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00780-0997
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-840-2747
Provider Business Practice Location Address Fax Number:
787-840-2747
Provider Enumeration Date:
03/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225400000X , with the licence number:  5716 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2-7599 . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 2501929 . This is a "ACAA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 600257 . This is a "MEDICARE MUCHO MAS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 223049 . This is a "PREFERED HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 4043 . This is a "PREFERED MEDICARE CHOICE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 9130001 . This is a "HUMANA INSURANCE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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