Provider Demographics
NPI:1487675062
Name:LOPEZ VIZCARRONDO, FRANK
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:
Last Name:LOPEZ VIZCARRONDO
Suffix:
Gender:M
Credentials:
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 777
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-0777
Mailing Address - Country:US
Mailing Address - Phone:787-883-5470
Mailing Address - Fax:787-270-3473
Practice Address - Street 1:L M RIVERA ESQUINA SEIJO
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:787-883-5470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1818208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR22514Medicare ID - Type Unspecified#MEDICARE