Provider Demographics
NPI:1306147665
Name:DR RAFAEL LUZARDO MEJIAS SERVICIOS MEDICOS DE PUERTO RICO
Entity type:Organization
Organization Name:DR RAFAEL LUZARDO MEJIAS SERVICIOS MEDICOS DE PUERTO RICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINADORA
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-725-4548
Mailing Address - Street 1:PO BOX 9023558
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00902-3558
Mailing Address - Country:US
Mailing Address - Phone:787-725-4548
Mailing Address - Fax:787-721-0279
Practice Address - Street 1:405 CALLE SAN FRANCISCO
Practice Address - Street 2:PISO 2 OFICINA 2 C
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00901-1772
Practice Address - Country:US
Practice Address - Phone:787-725-4548
Practice Address - Fax:787-721-0279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10607208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0082909Medicare UPIN