MEDICARE: JOEL VERA LP

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	224P00000X	Prosthetist	228	TX

General Provider Information

NPI Number	:	1720281660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL VERA LP

Provider Business Mailing Address
First Line	:	PO BOX 331580
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78463-1580
Country	:	US
Telephone Number	:	361-888-7752
Fax Number	:	361-888-7424

Provider Business Practice Location Address
First Line	:	1326 SANTA FE ST
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78404-2214
Country	:	US
Telephone Number	:	361-888-7752
Fax Number	:	361-888-7424

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

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	07/08/2007

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