MEDICARE: LMV GASTROENTEROLOGY PSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	17493	PR

General Provider Information

NPI Number	:	1386064558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LMV GASTROENTEROLOGY PSC

Provider Business Mailing Address
First Line	:	PO BOX 16598
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00908-6598
Country	:	US
Telephone Number	:	787-525-6075
Fax Number	:

Provider Business Practice Location Address
First Line	:	1449 CALLE AMERICO SALAS STE 103
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00909-2104
Country	:	US
Telephone Number	:	787-525-6075
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. LILLIANA MORALES-VASQUEZ
Credential	:	M.D.
Telephone Number	:	787-525-6075

Provider Enumeration Date	:	04/25/2014
Last Update Date	:	04/27/2014

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