Provider Demographics
NPI:1275207953
Name:FUENTES- LOPEZ, VICTOR RAFAEL (AU D)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:RAFAEL
Last Name:FUENTES- LOPEZ
Suffix:
Gender:M
Credentials:AU D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 44 BOX 12680
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-9732
Mailing Address - Country:US
Mailing Address - Phone:787-205-2676
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL MUNICIPAL MARIANO RIVERA RAMOS
Practice Address - Street 2:124 C SALVADOR BRAU 154 STE 101
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-205-2676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1021231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist