Provider Demographics
NPI:1053429076
Name:POLO, LUIS M (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:M
Last Name:POLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LUIS
Other - Middle Name:M
Other - Last Name:POLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:32 CALLE PONCE
Mailing Address - Street 2:HATO REY
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-5021
Mailing Address - Country:US
Mailing Address - Phone:787-996-2446
Mailing Address - Fax:787-296-0555
Practice Address - Street 1:32 CALLE PONCE
Practice Address - Street 2:HATO REY
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5021
Practice Address - Country:US
Practice Address - Phone:787-996-2446
Practice Address - Fax:787-296-0555
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR29392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry