Provider Demographics
NPI:1235229048
Name:LOPEZ LORENZO, VIVIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:
Last Name:LOPEZ LORENZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VIVIAN
Other - Middle Name:
Other - Last Name:LOPEZ LORENZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:HC 05
Mailing Address - Street 2:BOX 10763
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676
Mailing Address - Country:US
Mailing Address - Phone:787-877-4437
Mailing Address - Fax:
Practice Address - Street 1:3 CALLE LUIS MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-883-0124
Practice Address - Fax:787-883-0222
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14897208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR23383Medicare ID - Type Unspecified