=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871048918
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VMV NEFROLOGY & TRANSPLANT GROUP PSC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2016
-----------------------------------------------------
Last Update Date | 02/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | AVE PONCE DE LEON PDA 37 1/2
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00915-3959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-758-2500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 443 PASEO DORADO CUIDAD JARDIN
-----------------------------------------------------
City | CANOVANAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00729-9890
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | VERONICA MEZA VENENCIA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 787-587-9983
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | 17496
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------