1598854416 NPI number — DR. VANESSA E RAICES LOPEZ MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598854416 NPI number — DR. VANESSA E RAICES LOPEZ MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

RAICES LOPEZ

Provider First Name:

VANESSA

Provider Middle Name:

E

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

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:

1598854416

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/09/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

URB LUGARDO A 10

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

ARECIBO

Provider Business Mailing Address State Name:

PR

Provider Business Mailing Address Postal Code:

00612-0000

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

787-878-6089

Provider Business Mailing Address Fax Number:

787-878-6089

Provider First Line Business Practice Location Address:

URB GARCIA

Provider Second Line Business Practice Location Address:

60 CALLE TRINA PADILLA

Provider Business Practice Location Address City Name:

ARECIBO

Provider Business Practice Location Address State Name:

PR

Provider Business Practice Location Address Postal Code:

00612-0000

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

787-878-6089

Provider Business Practice Location Address Fax Number:

787-878-6089

Provider Enumeration Date:

10/11/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208D00000X , with the licence number:  14909 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 11914909 . This is a "GLOBAL HEALTH PLAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 6120199 . This is a "HUMANA PLAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 3114909 . This is a "UIA PLAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 1840 . This is a "PMC PLAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 2011058 . This is a "PREFERRED HEALTH PLAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 21844RA . This is a "SSS PLAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 04121A . This is a "AMERICAN HEALTH PLAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 100294 . This is a "CRUZ AZUL PLAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: P791 . This is a "FIRST MEDICAL PLAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 100160 . This is a "MMM PLAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: PG4725 . This is a "PALIC PLAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".