Provider Demographics
NPI:1477594489
Name:LOPEZ-HIDALGO, VICENTE (MD)
Entity Type:Individual
Prefix:DR
First Name:VICENTE
Middle Name:
Last Name:LOPEZ-HIDALGO
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 1:500 AVE MUNOZ RIVERA
Mailing Address - Street 2:EL CENTRO II SUITE 607
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3300
Mailing Address - Country:US
Mailing Address - Phone:787-764-2860
Mailing Address - Fax:
Practice Address - Street 1:500 AVE MUNOZ RIVERA
Practice Address - Street 2:EL CENTRO II SUITE 607
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3300
Practice Address - Country:US
Practice Address - Phone:787-764-2860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7359207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
7000000648Medicare UPIN
29541Medicare ID - Type Unspecified