Healthcare Provider Details

I. General information

NPI: 1407812381
Provider Name (Legal Business Name): ROBERTO E MERA LASTRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 02/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

A1 AVE AGUSTIN PEREZ ANDINO VILLAS DE RIO GRANDE
RIO GRANDE PR
00745-3000
US

IV. Provider business mailing address

NN13 CALLE ALMIRANTE MANSIONES DE CAROLINA
CAROLINA PR
00987-8101
US

V. Phone/Fax

Practice location:
  • Phone: 787-657-8543
  • Fax:
Mailing address:
  • Phone: 787-768-7479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number15354
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number15354
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: