Healthcare Provider Details

I. General information

NPI: 1235229048
Provider Name (Legal Business Name): VIVIAN LOPEZ LORENZO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VIVIAN LOPEZ LORENZO M.D.

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3081 AVE MILITAR
ISABELA PR
00662-4079
US

IV. Provider business mailing address

HC 5 BOX 10763
MOCA PR
00676-9761
US

V. Phone/Fax

Practice location:
  • Phone: 939-372-3481
  • Fax:
Mailing address:
  • Phone: 787-600-6525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number14897
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: