MEDICARE: LAS LOMAS MEDICAL GROUP CSP

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	208D00000X	General Practice Physician	9284	PR

General Provider Information

NPI Number	:	1528386190
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAS LOMAS MEDICAL GROUP CSP

Provider Business Mailing Address
First Line	:	CARRETERA 21 U3 -3
Second Line	:
City	:	RIO PIEDRAS
State	:	PR
Zip	:	00921-0000
Country	:	US
Telephone Number	:	787-783-6460
Fax Number	:	787-792-0018

Provider Business Practice Location Address
First Line	:	CARRETERA 21 U3 -3
Second Line	:
City	:	RIO PIEDRAS
State	:	PR
Zip	:	00921-0000
Country	:	US
Telephone Number	:	787-783-6460
Fax Number	:	787-792-0018

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VICTOR A APONTE
Credential	:	MD
Telephone Number	:	787-783-6460

Provider Enumeration Date	:	05/06/2010
Last Update Date	:	10/09/2013

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