1235240235 NPI number — JUAN CARLOS LOPEZ DE VICTORIA-RIVERA MD

Table of content: JUAN CARLOS LOPEZ DE VICTORIA-RIVERA MD (NPI 1235240235)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235240235 NPI number — JUAN CARLOS LOPEZ DE VICTORIA-RIVERA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOPEZ DE VICTORIA-RIVERA
Provider First Name:
JUAN
Provider Middle Name:
CARLOS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235240235
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4960
Provider Second Line Business Mailing Address:
PMB #381
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00726-4960
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-372-4022
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE LUIS MUNOZ RIVERA A-1 #402
Provider Second Line Business Practice Location Address:
CENTRO DE CIRUGIA AMBULATORIA HIMA/SAN PABLO CAGUAS
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725-4980
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-372-4022
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  MD429473 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 016783 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X , with the licence number: 036-113950 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)