Provider Demographics
NPI:1407812381
Name:MERA LASTRA, ROBERTO E (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:E
Last Name:MERA LASTRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NN13 CALLE ALMIRANTE
Mailing Address - Street 2:MANSIONES DE CAROLINA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-8101
Mailing Address - Country:US
Mailing Address - Phone:787-768-7479
Mailing Address - Fax:
Practice Address - Street 1:A1 AVE AGUSTIN PEREZ ANDINO
Practice Address - Street 2:VILLAS DE RIO GRANDE
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745-3000
Practice Address - Country:US
Practice Address - Phone:787-657-8543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15354207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRBZ114AMedicare PIN
PRI-48793Medicare UPIN