Basic Information
| Provider Information | |||||||||
| NPI: | 1619409752 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VERA-NIEVES | ||||||||
| FirstName: | BRYAN | ||||||||
| MiddleName: | AHMED | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 CALLE CASIA | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009213200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876417582 | ||||||||
| FaxNumber: | 7876414561 | ||||||||
| Practice Location | |||||||||
| Address1: | 4710 N HABANA AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336147146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8134503457 | ||||||||
| FaxNumber: | 8772353648 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2017 | ||||||||
| LastUpdateDate: | 07/22/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RI0200X | ME154735 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | ME154735 | 01 | FL | MEDICAL LICENSE | OTHER |