Provider Demographics
NPI:1942219902
Name:VIZCARRONDO-ACOSTA, NOEMI (MD)
Entity Type:Individual
Prefix:DR
First Name:NOEMI
Middle Name:
Last Name:VIZCARRONDO-ACOSTA
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 1:23 ESMERALDA
Mailing Address - Street 2:MANSIONES DE SAN RAFAEL
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-760-8365
Mailing Address - Fax:787-786-8615
Practice Address - Street 1:AVE. LAUREL HOSPITAL REGIONAL BAYAMON
Practice Address - Street 2:CENTRO PEDIATRICO DE BAYAMON
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-778-4747
Practice Address - Fax:787-786-8615
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR5227208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics