Provider Demographics
NPI: | 1790108322 |
---|---|
Name: | LOVIZCA |
Entity Type: | Organization |
Organization Name: | LOVIZCA |
Other - Org Name: | LOVIZCA INC |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | ORTHOPEDIC SURGEON |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | BENIGNO |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | LOPEZ |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 787-672-2533 |
Mailing Address - Street 1: | PO BOX 760 |
Mailing Address - Street 2: | |
Mailing Address - City: | CAGUAS |
Mailing Address - State: | PR |
Mailing Address - Zip Code: | 00726-0760 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 787-672-2533 |
Mailing Address - Fax: | |
Practice Address - Street 1: | CALLE MUNOZ RIVERA #1 FINAL |
Practice Address - Street 2: | CENTRO AMBULATORIO HIMA SAN PABLO CAGUAS |
Practice Address - City: | CAGUAS |
Practice Address - State: | PR |
Practice Address - Zip Code: | 00725-0760 |
Practice Address - Country: | US |
Practice Address - Phone: | 787-672-2533 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-02-03 |
Last Update Date: | 2014-02-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PR | 4588 | 174400000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 174400000X | Other Service Providers | Specialist | Group - Multi-Specialty |