Provider Demographics
NPI:1871544304
Name:FERMIN VALDEZ, LUIS R (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:R
Last Name:FERMIN VALDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 43002
Mailing Address - Street 2:SUITE 151
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-6601
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CALLE MAIN AA 4
Practice Address - Street 2:URB ALTURAS DE RIO GRANDE
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-500-7270
Practice Address - Fax:787-500-7270
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR11603208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0088969Medicaid
H55676Medicare UPIN