Provider Demographics
NPI:1487705141
Name:NOBO, ULISES LISANDRO (MD)
Entity type:Individual
Prefix:MR
First Name:ULISES
Middle Name:LISANDRO
Last Name:NOBO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:ULISES
Other - Middle Name:LISANDRO
Other - Last Name:NOBO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:URB EL VALLE
Mailing Address - Street 2:164 CALLE BUCANO GIGANTE
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727
Mailing Address - Country:US
Mailing Address - Phone:787-653-3191
Mailing Address - Fax:787-653-1789
Practice Address - Street 1:AVE LUIS MUNOZ MARIN HIMA SAN PABLO
Practice Address - Street 2:SOTANO DPTO NEUROLOGIA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-653-1764
Practice Address - Fax:787-653-1789
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-120822084N0400X
TN587632084N0400X
MS265122084P0800X
PR167102084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH90054Medicare UPIN