Provider Demographics
NPI:1154450112
Name:VIZCARRONDO, NILSA M (MD)
Entity Type:Individual
Prefix:MRS
First Name:NILSA
Middle Name:M
Last Name:VIZCARRONDO
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 5
Mailing Address - Street 2:REXMANOR C# 12
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784
Mailing Address - Country:US
Mailing Address - Phone:787-864-2168
Mailing Address - Fax:787-866-2112
Practice Address - Street 1:STREET 5
Practice Address - Street 2:REXMANOR C# 12
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-864-2168
Practice Address - Fax:787-866-2112
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5640207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2-8157Medicare ID - Type UnspecifiedMEDICARE IDENTIFICATION