=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467584706
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VERA LOURO ARENA MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | AV. PONCE DE LEON MERCANTIL PLAZA, PISO 14
-----------------------------------------------------
City | HATO REY
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00936-8401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-754-8989
-----------------------------------------------------
Fax | 787-250-1689
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11710 OLD GEORGETOWN RD APT 317
-----------------------------------------------------
City | NORTH BETHESDA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20852-2691
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-731-8068
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 16195
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------