Healthcare Provider Details

I. General information

NPI: 1336121425
Provider Name (Legal Business Name): FERNANDO VIZCARRONDO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 11/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 AVE DE DIEGO OF. 301 TORRE SAN FRANCISCO
SAN JUAN PR
00923-3003
US

IV. Provider business mailing address

A7 CALLE HUCAR VILLA HUCAR
SAN JUAN PR
00926-6818
US

V. Phone/Fax

Practice location:
  • Phone: 787-754-0055
  • Fax: 787-754-0061
Mailing address:
  • Phone: 787-754-0055
  • Fax: 787-754-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number6479
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: