Basic Information
| Provider Information | |||||||||
| NPI: | 1538632724 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LUMEN VERA,MD PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1327 | ||||||||
| Address2: | |||||||||
| City: | AIBONITO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007051327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877350023 | ||||||||
| FaxNumber: | 7879917097 | ||||||||
| Practice Location | |||||||||
| Address1: | CARRETERA 726 KM 0.4 BO CAONILLAS | ||||||||
| Address2: | HOSPITAL GENERAL MENONITA | ||||||||
| City: | AIBONITO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007051327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877350023 | ||||||||
| FaxNumber: | 7879917097 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2019 | ||||||||
| LastUpdateDate: | 01/10/2019 | ||||||||
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| AuthorizedOfficialLastName: | VERA COLON | ||||||||
| AuthorizedOfficialFirstName: | LUMEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7877350023 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.