Provider Demographics
NPI:1194088203
Name:ALIAGA, LUIS RAUL
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:RAUL
Last Name:ALIAGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15470 SW 74 CIRCLE APT # 907
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193
Mailing Address - Country:US
Mailing Address - Phone:305-551-2224
Mailing Address - Fax:
Practice Address - Street 1:15470 SW 74TH CIRCLE CT APT 907
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-3353
Practice Address - Country:US
Practice Address - Phone:305-551-2224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA65148172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist