Provider Demographics
NPI:1184848210
Name:LOPEZ-BRACETTY, DORIAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:DORIAN
Middle Name:M
Last Name:LOPEZ-BRACETTY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:35 CALLE JUAN C BORBON STE 67-465
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5374
Mailing Address - Country:US
Mailing Address - Phone:787-525-0731
Mailing Address - Fax:787-848-0318
Practice Address - Street 1:311 AVE DOMENECH
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3511
Practice Address - Country:US
Practice Address - Phone:787-758-2525
Practice Address - Fax:787-848-0318
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR16661208VP0014X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0027520Medicare PIN