MEDICARE: DR. DORIAN M LOPEZ-BRACETTY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0014X	Interventional Pain Medicine Physician	16661	PR
2	207L00000X	Anesthesiology Physician	16661	PR

General Provider Information

NPI Number	:	1184848210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DORIAN M LOPEZ-BRACETTY MD

Provider Business Mailing Address
First Line	:	35 CALLE JUAN C BORBON STE 67-465
Second Line	:
City	:	GUAYNABO
State	:	PR
Zip	:	00969-5374
Country	:	US
Telephone Number	:	787-525-0731
Fax Number	:	787-848-0318

Provider Business Practice Location Address
First Line	:	311 AVE DOMENECH
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00918-3511
Country	:	US
Telephone Number	:	787-758-2525
Fax Number	:	787-848-0318

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	02/03/2010

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