Provider Demographics
NPI:1902808553
Name:FORASTIERI, LUIS J (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:J
Last Name:FORASTIERI
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 995
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-0995
Mailing Address - Country:US
Mailing Address - Phone:787-704-3435
Mailing Address - Fax:787-704-3440
Practice Address - Street 1:1 CALLE NAZARIO
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-2683
Practice Address - Country:US
Practice Address - Phone:787-704-3435
Practice Address - Fax:787-704-3440
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR134332084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH80800Medicare UPIN
PR20230Medicare ID - Type Unspecified