Provider Demographics
NPI:1235240235
Name:LOPEZ DE VICTORIA-RIVERA, JUAN CARLOS (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:CARLOS
Last Name:LOPEZ DE VICTORIA-RIVERA
Suffix:
Gender:M
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:PO BOX 4960
Mailing Address - Street 2:PMB #381
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-4960
Mailing Address - Country:US
Mailing Address - Phone:787-372-4022
Mailing Address - Fax:
Practice Address - Street 1:AVE LUIS MUNOZ RIVERA A-1 #402
Practice Address - Street 2:CENTRO DE CIRUGIA AMBULATORIA HIMA/SAN PABLO CAGUAS
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-4980
Practice Address - Country:US
Practice Address - Phone:787-372-4022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD429473208600000X
PR016783208600000X
IL036-113950208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery