MEDICARE: DR. MAYRA VERA D.MD.

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	1223G0001X	General Practice Dentistry	1591	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	041639	OTHER	PR	LA CRUZ AZUL DE PR
2	206661	OTHER	PR	PREFERRED HEALTH PLAN
3	6280051	OTHER	PR	HUMANA DE PR
4	41441VE	OTHER	PR	TRIPLE-S, INC.
5	2448	OTHER	PR	FIRST MEDICAL

General Provider Information

NPI Number	:	1740285717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAYRA VERA D.MD.

Provider Business Mailing Address
First Line	:	PO BOX 1892
Second Line	:
City	:	CAROLINA
State	:	PR
Zip	:	00984-1892
Country	:	US
Telephone Number	:	787-762-0069
Fax Number	:	787-762-1822

Provider Business Practice Location Address
First Line	:	FIDALGO DIAZ AVE.
Second Line	:	DL-4 VILLA FONTANA
City	:	CAROLINA
State	:	PR
Zip	:	00983
Country	:	US
Telephone Number	:	787-762-0069
Fax Number	:	787-762-1822

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. MAYRA VERA D.MD.” Practice Location

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