MEDICARE: LUNARIS MEDICAL CLINIC LLC

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

General Provider Information

NPI Number	:	1902730252
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUNARIS MEDICAL CLINIC LLC

Provider Business Mailing Address
First Line	:	3536 AVE SUR, COND THE RESIDENCES
Second Line	:	1913
City	:	CAROLINA
State	:	PR
Zip	:	00987-5010
Country	:	US
Telephone Number	:	787-409-8918
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 CALLE GAUTIER BENITEZ
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00725-5527
Country	:	US
Telephone Number	:	787-409-8918
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MORAYMA ENID RIVERA NIEVES
Credential	:	MEDICO
Telephone Number	:	787-409-8918

Provider Enumeration Date	:	06/11/2026
Last Update Date	:	06/11/2026

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