Provider Demographics
NPI:1982710117
Name:FRIAS, LUIS ALEXANDER
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:ALEXANDER
Last Name:FRIAS
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:D3 COAKLEY BAY CONDOMINIUM
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00820
Mailing Address - Country:US
Mailing Address - Phone:787-306-7821
Mailing Address - Fax:
Practice Address - Street 1:1 ESTATE CANE STE 207
Practice Address - Street 2:
Practice Address - City:FREDERIKSTED
Practice Address - State:VI
Practice Address - Zip Code:00840-4425
Practice Address - Country:US
Practice Address - Phone:340-773-0007
Practice Address - Fax:340-772-5755
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR133912084N0400X, 2084N0600X
VI21182084N0600X, 2084N0400X
TXN36512084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR601915OtherMMM
PR6830050OtherHUMANA
PR1301918OtherACAA
PR13391OtherSSBV
PR90325OtherSSS
PR061782OtherCRUZ AZUL
PR13391OtherDEPT. OF VETERANS AFFAIRS
PR1301918OtherACAA
PR90328Medicare ID - Type Unspecified