Provider Demographics
NPI:1992843569
Name:NUNEZ, LUIS RAFAEL (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:RAFAEL
Last Name:NUNEZ
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 1:8 CALLE COBALLES GANDIA
Mailing Address - Street 2:URB. VILLAMAR
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-4432
Mailing Address - Country:US
Mailing Address - Phone:787-878-7086
Mailing Address - Fax:787-817-2334
Practice Address - Street 1:8 CALLE COBALLES GANDIA
Practice Address - Street 2:URB. VILLAMAR
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4432
Practice Address - Country:US
Practice Address - Phone:787-878-7086
Practice Address - Fax:787-817-2334
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5081171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0025594Medicare ID - Type Unspecified
PRD48315Medicare UPIN