Provider Demographics
NPI:1114366861
Name:LOMONACO, MAYRA R (MD)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:R
Last Name:LOMONACO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1515 N FLAGLER DR STE 430
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3430
Mailing Address - Country:US
Mailing Address - Phone:561-659-6336
Mailing Address - Fax:561-659-9353
Practice Address - Street 1:6056 BOYNTON BEACH BLVD STE 245
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3587
Practice Address - Country:US
Practice Address - Phone:561-659-6336
Practice Address - Fax:561-659-9353
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLTRN19212207R00000X
FLME137220207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine