Provider Demographics
NPI:1982683819
Name:CHAPA JUAN, VICENTE (MD)
Entity Type:Individual
Prefix:
First Name:VICENTE
Middle Name:
Last Name:CHAPA JUAN
Suffix:
Gender:M
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:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-0009
Mailing Address - Country:US
Mailing Address - Phone:787-733-5527
Mailing Address - Fax:787-733-5527
Practice Address - Street 1:C RAMOS ANTONINI 4
Practice Address - Street 2:
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771
Practice Address - Country:US
Practice Address - Phone:787-733-5527
Practice Address - Fax:787-733-5527
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8334208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
E79248Medicare UPIN
29759CHMedicare ID - Type Unspecified