Provider Demographics
NPI:1336121425
Name:VIZCARRONDO, FERNANDO (MD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:
Last Name:VIZCARRONDO
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:A7 CALLE HUCAR
Mailing Address - Street 2:VILLA HUCAR
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6818
Mailing Address - Country:US
Mailing Address - Phone:787-754-0055
Mailing Address - Fax:787-754-0061
Practice Address - Street 1:369 AVE DE DIEGO
Practice Address - Street 2:OF. 301 TORRE SAN FRANCISCO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-3003
Practice Address - Country:US
Practice Address - Phone:787-754-0055
Practice Address - Fax:787-754-0061
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6479208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR26566Medicare ID - Type Unspecified