MEDICARE: LOURDES VIZCARRA MD

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	207Q00000X	Family Medicine Physician	2002-0496	NM
2	207Q00000X	Family Medicine Physician	31251	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427065473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOURDES VIZCARRA MD

Provider Business Mailing Address
First Line	:	2350 ALAMO AVE SE SUITE 160
Second Line	:	MSC11 6295
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2350 ALAMO AVE SE STE 160
Second Line	:	MSC11 6295
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-3225
Country	:	US
Telephone Number	:	505-925-2350
Fax Number	:

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

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	12/02/2015

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Directions to “ LOURDES VIZCARRA MD” Practice Location

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