Provider Demographics
NPI:1124061205
Name:GHIGLIOTTI, LUIS DOMINGO (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:DOMINGO
Last Name:GHIGLIOTTI
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 1:414 CALLE MILLITO NAVARRO
Mailing Address - Street 2:ESTANCIAS DEL GOLF CLUB
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-0522
Mailing Address - Country:US
Mailing Address - Phone:787-290-2291
Mailing Address - Fax:
Practice Address - Street 1:1010 PASEO DEL VETERANO
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-2001
Practice Address - Country:US
Practice Address - Phone:787-641-7582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12195174400000X
PR12,195207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist