Provider Demographics
NPI:1528386190
Name:LAS LOMAS MEDICAL GROUP CSP
Entity Type:Organization
Organization Name:LAS LOMAS MEDICAL GROUP CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:A
Authorized Official - Last Name:APONTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-783-6460
Mailing Address - Street 1:CARRETERA 21 U3 -3
Mailing Address - Street 2:
Mailing Address - City:RIO PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00921-0000
Mailing Address - Country:US
Mailing Address - Phone:787-783-6460
Mailing Address - Fax:787-792-0018
Practice Address - Street 1:CARRETERA 21 U3 -3
Practice Address - Street 2:
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00921-0000
Practice Address - Country:US
Practice Address - Phone:787-783-6460
Practice Address - Fax:787-792-0018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9284208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty