Provider Demographics
NPI:1548304926
Name:AMADEO, LUIS JAVIER
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:JAVIER
Last Name:AMADEO
Suffix:
Gender:M
Credentials:
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 358
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-0358
Mailing Address - Country:US
Mailing Address - Phone:787-883-3140
Mailing Address - Fax:
Practice Address - Street 1:72 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692-6528
Practice Address - Country:US
Practice Address - Phone:787-883-3140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy