Provider Demographics
NPI:1487623385
Name:FERNANDEZ-BRITO, LUIS M (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:M
Last Name:FERNANDEZ-BRITO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:CALLE 1 N-14
Mailing Address - Street 2:VILLA HUMACAO
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-0001
Mailing Address - Country:US
Mailing Address - Phone:787-285-6557
Mailing Address - Fax:787-285-6557
Practice Address - Street 1:CALLE ANTONIO LOPEZ
Practice Address - Street 2:#52
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-285-6557
Practice Address - Fax:787-285-6557
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12171208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0020450Medicare PIN
PRH42455Medicare UPIN