Provider Demographics
NPI:1912242751
Name:HCO DR. MANUEL VIZCARRONDO
Entity Type:Organization
Organization Name:HCO DR. MANUEL VIZCARRONDO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VIZCARRONDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-824-6392
Mailing Address - Street 1:PO BOX
Mailing Address - Street 2:2342
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785
Mailing Address - Country:US
Mailing Address - Phone:787-824-6392
Mailing Address - Fax:
Practice Address - Street 1:BALDORIOTY
Practice Address - Street 2:59
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751
Practice Address - Country:US
Practice Address - Phone:787-824-6392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208D00000X
PR8733302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty