=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790108322
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOVIZCA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2014
-----------------------------------------------------
Last Update Date | 02/03/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CALLE MUNOZ RIVERA #1 FINAL CENTRO AMBULATORIO HIMA SAN PABLO CAGUAS
-----------------------------------------------------
City | CAGUAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00725-0760
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-672-2533
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 760
-----------------------------------------------------
City | CAGUAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00726-0760
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-672-2533
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ORTHOPEDIC SURGEON
-----------------------------------------------------
Name | DR. BENIGNO LOPEZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 787-672-2533
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 4588
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------