Healthcare Provider Details

I. General information

NPI: 1902730252
Provider Name (Legal Business Name): LUNARIS MEDICAL CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CALLE GAUTIER BENITEZ
CAGUAS PR
00725-5527
US

IV. Provider business mailing address

3536 AVE SUR, COND THE RESIDENCES 1913
CAROLINA PR
00987-5010
US

V. Phone/Fax

Practice location:
  • Phone: 787-409-8918
  • Fax:
Mailing address:
  • Phone: 787-409-8918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MORAYMA ENID RIVERA NIEVES
Title or Position: OWNER
Credential: MEDICO
Phone: 787-409-8918