Provider Demographics
NPI:1538172341
Name:DELIZ-VARELA, LUIS J (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:J
Last Name:DELIZ-VARELA
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 577
Mailing Address - Street 2:
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637-0577
Mailing Address - Country:US
Mailing Address - Phone:787-873-3005
Mailing Address - Fax:787-873-6187
Practice Address - Street 1:8 CALLE JULIO VICTOR NUNEZ
Practice Address - Street 2:
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637-1912
Practice Address - Country:US
Practice Address - Phone:787-873-3005
Practice Address - Fax:787-873-6187
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5962207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7470013OtherHUMANA
PR100146WOtherMEDICARE Y MUCHO MAS
PR066885OtherCRUZ AZUL
PR1460OtherPMC CHOICE
PR2149OtherFIRST MEDICAL
PR25818DEOtherSSS
PR1460OtherPMC CHOICE
PR25818Medicare PIN