Basic Information
| Provider Information | |||||||||
| NPI: | 1568586287 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DELGADO MATEU | ||||||||
| FirstName: | LUIS | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 295 PALMAS INN WAY | ||||||||
| Address2: | SUITE 130 PMB 124 | ||||||||
| City: | HUMACAO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007916181 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7874033770 | ||||||||
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| Practice Location | |||||||||
| Address1: | HOSP. DR. ISAACGONZALEZ MARTINEZ | ||||||||
| Address2: | AVE. AMERICO MIRANDA | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877634149 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2007 | ||||||||
| LastUpdateDate: | 03/23/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 11592 | PR | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 11592 | 01 | PR | PRACTICE LICENSE | OTHER |