MEDICARE: DR. ALEJANDRA THOMAS VISSEPO M.D.

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	16327	PR

General Provider Information

NPI Number	:	1215901442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEJANDRA THOMAS VISSEPO M.D.

Provider Business Mailing Address
First Line	:	1151 CALLE 4 SE
Second Line	:	CAPARRA TERRACE
City	:	SAN JUAN
State	:	PR
Zip	:	00921-1734
Country	:	US
Telephone Number	:	787-243-2984
Fax Number	:

Provider Business Practice Location Address
First Line	:	1151 CALLE 4 SE
Second Line	:	CAPARRA TERRACE
City	:	SAN JUAN
State	:	PR
Zip	:	00921-1734
Country	:	US
Telephone Number	:	787-243-2984
Fax Number	:

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

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	10/02/2012

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