Provider Demographics
NPI:1861550550
Name:IGUINA MELLA, LUIS ENRIQUE (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ENRIQUE
Last Name:IGUINA MELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 140397
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614
Mailing Address - Country:US
Mailing Address - Phone:787-879-3346
Mailing Address - Fax:787-880-1148
Practice Address - Street 1:AVE JOSE DE DIEGO #158
Practice Address - Street 2:CABAN BUILDING, SUITE 101
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-879-3346
Practice Address - Fax:787-880-1148
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR7141208G00000X
AZ14741208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
C79707Medicare UPIN
PR27908Medicare PIN