=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538632724
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUMEN VERA,MD PSC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2019
-----------------------------------------------------
Last Update Date | 01/10/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARRETERA 726 KM 0.4 BO CAONILLAS HOSPITAL GENERAL MENONITA
-----------------------------------------------------
City | AIBONITO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00705-1327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-735-0023
-----------------------------------------------------
Fax | 787-991-7097
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1327
-----------------------------------------------------
City | AIBONITO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00705-1327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-735-0023
-----------------------------------------------------
Fax | 787-991-7097
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. LUMEN VERA COLON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 787-735-0023
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------