MEDICARE: DR. JOSE LUIS VERA-MIRO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	9213	PR

General Provider Information

NPI Number	:	1548266968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE LUIS VERA-MIRO M.D.

Provider Business Mailing Address
First Line	:	5 AVE. SAN CRISTOBAL
Second Line	:	207 TORRE SAN CRISTOBAL
City	:	COTO LAUREL
State	:	PR
Zip	:	00780-2847
Country	:	US
Telephone Number	:	787-842-2073
Fax Number	:	787-842-2071

Provider Business Practice Location Address
First Line	:	5 AVE. SAN CRISTOBAL
Second Line	:	207 TORRE SAN CRISTOBAL
City	:	COTO LAUREL
State	:	PR
Zip	:	00780-2847
Country	:	US
Telephone Number	:	787-842-2073
Fax Number	:	787-842-2071

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	09/09/2010

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