Provider Demographics
NPI:1598854416
Name:RAICES LOPEZ, VANESSA E (MD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:E
Last Name:RAICES LOPEZ
Suffix:
Gender:F
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:URB LUGARDO A 10
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-0000
Mailing Address - Country:US
Mailing Address - Phone:787-878-6089
Mailing Address - Fax:787-878-6089
Practice Address - Street 1:URB GARCIA
Practice Address - Street 2:60 CALLE TRINA PADILLA
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-0000
Practice Address - Country:US
Practice Address - Phone:787-878-6089
Practice Address - Fax:787-878-6089
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14909208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR11914909OtherGLOBAL HEALTH PLAN
PR6120199OtherHUMANA PLAN
PR3114909OtherUIA PLAN
PR1840OtherPMC PLAN
PR2011058OtherPREFERRED HEALTH PLAN
PR21844RAOtherSSS PLAN
PR04121AOtherAMERICAN HEALTH PLAN
PR100294OtherCRUZ AZUL PLAN
PRP791OtherFIRST MEDICAL PLAN
PR100160OtherMMM PLAN
PRPG4725OtherPALIC PLAN
PR1840OtherPMC PLAN
PR0021844Medicare ID - Type UnspecifiedMEDICARE BILLING NUMBER