Provider Demographics
NPI:1780731257
Name:THOMAS NAMNOUM, LESA A (MD)
Entity type:Individual
Prefix:DR
First Name:LESA
Middle Name:A
Last Name:THOMAS NAMNOUM
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 1:13914 CONDO PLAYA BUYE
Mailing Address - Street 2:APT 204
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623
Mailing Address - Country:US
Mailing Address - Phone:787-237-3438
Mailing Address - Fax:
Practice Address - Street 1:PR RENAL HEALTH
Practice Address - Street 2:BUILDING OFFICE PARK IV, #201 STREET ROAD #2 KM 156.5
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-986-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11054207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF96569Medicare UPIN
PR21653Medicare PIN
PR796569Medicare ID - Type Unspecified