MEDICARE: DR. CARLOS A LOPEZ DE VICTORIA CABRERA

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	208D00000X	General Practice Physician	11252	PR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	3202	OTHER	PR	PMC-MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	119-11752	OTHER	PR	GLOBAL HEATH PLAN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336165281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLOS A LOPEZ DE VICTORIA CABRERA

Provider Business Mailing Address
First Line	:	802 CALLE CAMPECHE
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00717-1770
Country	:	US
Telephone Number	:	787-843-6174
Fax Number	:	787-843-6174

Provider Business Practice Location Address
First Line	:	10 CALLE CONCEPCION STE 1
Second Line	:
City	:	GUAYANILLA
State	:	PR
Zip	:	00656-1710
Country	:	US
Telephone Number	:	787-835-8237
Fax Number	:	787-835-8237

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	07/08/2007

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