Provider Demographics
NPI:1942626148
Name:LAS LOMAS MEDICAL GROUP CSP
Entity Type:Organization
Organization Name:LAS LOMAS MEDICAL GROUP CSP
Other - Org Name:CENTRO MEDICO LAS LOMAS
Other - Org Type:Doing Business As
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:U3-3 CARR 21
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-3313
Mailing Address - Country:US
Mailing Address - Phone:787-783-6460
Mailing Address - Fax:787-792-0018
Practice Address - Street 1:U3-3 CARR 21
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3313
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:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRHO718AMedicare PIN