MEDICARE: NILSA MARIE RIVERA LEZCANO MD

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	208D00000X	General Practice Physician	022047	PR
2	208D00000X	General Practice Physician	22047	PR

General Provider Information

NPI Number	:	1780274910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NILSA MARIE RIVERA LEZCANO MD

Provider Business Mailing Address
First Line	:	1014 CALLE CAONILLA
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00725-7630
Country	:	US
Telephone Number	:	787-567-7924
Fax Number	:

Provider Business Practice Location Address
First Line	:	1014 CALLE CAONILLA
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00725-7630
Country	:	US
Telephone Number	:	787-567-7924
Fax Number	:

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

Provider Enumeration Date	:	01/21/2021
Last Update Date	:	07/27/2021

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