Provider Demographics
NPI:1659502458
Name:VERAS MENA, LAURA ISABEL (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ISABEL
Last Name:VERAS MENA
Suffix:
Gender:F
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:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-9722
Mailing Address - Fax:239-343-9725
Practice Address - Street 1:3501 HEALTH CENTER BLVD STE 2120
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:34135-8128
Practice Address - Country:US
Practice Address - Phone:239-495-4390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME137663207K00000X
MI4301095114207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200541620AMedicaid
KS201094720AMedicaid
FL102791200Medicaid