Provider Demographics
NPI:1255446944
Name:LOPEZ DE VICTORIA, JOSE R (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:R
Last Name:LOPEZ DE VICTORIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1048
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-1048
Mailing Address - Country:US
Mailing Address - Phone:787-786-5151
Mailing Address - Fax:787-786-5153
Practice Address - Street 1:100 PASEO SAN PABLO
Practice Address - Street 2:DR. ARTURO CADILLA BUILDING SUITE 205
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7019
Practice Address - Country:US
Practice Address - Phone:787-786-5151
Practice Address - Fax:787-786-5153
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR7237208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR98950OtherTRIPLE S PROVIDER NUMBER
PR98950Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
PRD32371Medicare UPIN