1790780914 NPI number — DR. LUIS ROBERTO CANAS MD

Table of content: DR. LUIS ROBERTO CANAS MD (NPI 1790780914)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790780914 NPI number — DR. LUIS ROBERTO CANAS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CANAS
Provider First Name:
LUIS
Provider Middle Name:
ROBERTO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1790780914
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AIBONITO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00705-2000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-638-0246
Provider Business Mailing Address Fax Number:
787-735-2268

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
38C CALLE 1
Provider Second Line Business Practice Location Address:
VILLA ROSALES
Provider Business Practice Location Address City Name:
AIBONITO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-735-7859
Provider Business Practice Location Address Fax Number:
787-954-7501
Provider Enumeration Date:
06/15/2005

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: 207R00000X , with the licence number:  5047 , 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: 6090029 . This is a "HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 26061 . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: M0247 . This is a "PLAN MENONITA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 26061 . This is a "MEDICARE PTAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 400012 . This is a "MEDICARE Y MUCHO MAS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 063965 . This is a "LA CRUZ AZUL DE P.R." identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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