Provider Demographics
NPI:1194787036
Name:WALTERS MARQUEZ, LUIS A
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:A
Last Name:WALTERS MARQUEZ
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 1:511 AVE DE HOSTOS
Mailing Address - Street 2:BALDRICH
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-250-6493
Mailing Address - Fax:787-250-6493
Practice Address - Street 1:AVE DE HOSTOS #511
Practice Address - Street 2:BALDRICH
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-250-6493
Practice Address - Fax:787-250-6493
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0028213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T26841Medicare UPIN
48023Medicare ID - Type Unspecified