Healthcare Provider Details

I. General information

NPI: 1780731257
Provider Name (Legal Business Name): LESA A THOMAS NAMNOUM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PR RENAL HEALTH BUILDING OFFICE PARK IV, #201 STREET ROAD #2 KM 156.5
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

13914 CONDO PLAYA BUYE APT 204
CABO ROJO PR
00623
US

V. Phone/Fax

Practice location:
  • Phone: 787-986-5050
  • Fax:
Mailing address:
  • Phone: 787-237-3438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number11054
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: