Healthcare Provider Details

I. General information

NPI: 1477594489
Provider Name (Legal Business Name): VICENTE LOPEZ-HIDALGO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 02/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 AVE MUNOZ RIVERA EL CENTRO II SUITE 607
SAN JUAN PR
00918-3300
US

IV. Provider business mailing address

500 AVE MUNOZ RIVERA EL CENTRO II SUITE 607
SAN JUAN PR
00918-3300
US

V. Phone/Fax

Practice location:
  • Phone: 787-764-2860
  • Fax:
Mailing address:
  • Phone: 787-764-2860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number7359
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: