Active NPI
Ivan Lorenzo Viera- San Martin, MSN
- Gerontology Clinical Nurse Specialist
- Vega Alta, PR
National Provider Identifier
1144787458
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gerontology Clinical Nurse Specialist
- License
- E1779
- Practice address
- 78 Plaza Fabiola
Estancias de Cerro Gordo
Vega Alta, PR 00692-9125 - Phone
- (787) 717-2568
- NPI assigned
- Feb 22, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gerontology Clinical Nurse Specialist | 364SG0600X | E1779 | PR | Primary |
Addresses
Primary practice location
78 Plaza Fabiola
Estancias de Cerro Gordo
Vega Alta, PR 00692-9125
Mailing address
78 Plaza Fabiola
Estancias de Cerro Gordo
Vega Alta, PR 00692-9125
Phone (787) 717-2568
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1187382 | Other | PR | DRIVER LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science - Nursing
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E1779 | PR | MD | Gerontology Clinical Nurse Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1550793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1550793600000",
"number": "1144787458",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "78 PLAZA FABIOLA",
"address_2": "ESTANCIAS DE CERRO GORDO",
"city": "VEGA ALTA",
"state": "PR",
"postal_code": "006929125",
"telephone_number": "787-717-2568"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "78 PLAZA FABIOLA",
"address_2": "ESTANCIAS DE CERRO GORDO",
"city": "VEGA ALTA",
"state": "PR",
"postal_code": "006929125",
"telephone_number": "787-717-2568"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VIERA- SAN MARTIN",
"first_name": "IVAN",
"middle_name": "LORENZO",
"credential": "MSN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-02-22",
"last_updated": "2019-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "364SG0600X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Clinical Nurse Specialist, Gerontology",
"state": "PR",
"license": "E1779",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DRIVER LICENSE",
"identifier": "1187382",
"state": "PR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vega Alta, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.