Healthcare Provider Details

I. General information

NPI: 1891663753
Provider Name (Legal Business Name): BRYAN VERA INFECTIOUS DISEASE SPECIALIST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 10/23/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 AVE TITO CASTRO
PONCE PR
00716-4717
US

IV. Provider business mailing address

URB TERRA SENORIAL 123 CALLE CASTANIA
PONCE PR
00731-9558
US

V. Phone/Fax

Practice location:
  • Phone: 787-844-2080
  • Fax:
Mailing address:
  • Phone: 786-759-0087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: BRYAN AHMED VERA NIEVES
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 786-769-0087