Provider Demographics
NPI:1992252589
Name:GRAULAU BURGOS, LUIS ALFREDO (MD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:ALFREDO
Last Name:GRAULAU BURGOS
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:PO BOX 132
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-0132
Mailing Address - Country:US
Mailing Address - Phone:787-677-2691
Mailing Address - Fax:
Practice Address - Street 1:URB INDUSTRIAL REPARADA #2 CALLE DR LUIS F SALA 396
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:787-812-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR222362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry