Healthcare Provider Details

I. General information

NPI: 1023854783
Provider Name (Legal Business Name): GEAN CARLOS VINER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. ESTATAL PR 14, INTERIOR, KM 0.3 BARRIO RINCON, SECTOR LOMAS
CAYEY PR
00737
US

IV. Provider business mailing address

CARR. ESTATAL PR 14, INTERIOR, KM 0.3 BARRIO RINCON, SECTOR LOMAS
CAYEY PR
00737
US

V. Phone/Fax

Practice location:
  • Phone: 480-298-1464
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number24577
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number24577
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: