Provider Demographics
NPI:1134765753
Name:LAMOURT, ERICA IVELLISSE (MD)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:IVELLISSE
Last Name:LAMOURT
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:CALLE VIA GIRASOLES
Mailing Address - Street 2:MANSION DEL SOL MS-7
Mailing Address - City:SABANA SECA
Mailing Address - State:PR
Mailing Address - Zip Code:00952
Mailing Address - Country:US
Mailing Address - Phone:787-510-7976
Mailing Address - Fax:
Practice Address - Street 1:CALLE VIA GIRASOLES
Practice Address - Street 2:MANSION DEL SOL MS7
Practice Address - City:SABANA SECA
Practice Address - State:PR
Practice Address - Zip Code:00952
Practice Address - Country:US
Practice Address - Phone:787-510-7976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21615208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice