Provider Demographics
NPI:1568450492
Name:LOPEZ DE VICTORIA RIVERA, ORLANDO R (MD)
Entity Type:Individual
Prefix:DR
First Name:ORLANDO
Middle Name:R
Last Name:LOPEZ DE VICTORIA RIVERA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1 CALLE A
Mailing Address - Street 2:URB GARCIA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5108
Mailing Address - Country:US
Mailing Address - Phone:787-740-4740
Mailing Address - Fax:787-269-6067
Practice Address - Street 1:BAYAMON MEDICAL PLZ
Practice Address - Street 2:SUITE 710
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-7200
Practice Address - Country:US
Practice Address - Phone:787-740-4740
Practice Address - Fax:787-269-6067
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2014-09-10
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Provider Licenses
StateLicense IDTaxonomies
PR10564208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG41678Medicare UPIN