MEDICARE: DR. ORLANDO R LOPEZ DE VICTORIA RIVERA 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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	10564	PR

General Provider Information

NPI Number	:	1568450492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ORLANDO R LOPEZ DE VICTORIA RIVERA M.D.

Provider Business Mailing Address
First Line	:	1 CALLE A
Second Line	:	URB GARCIA
City	:	SAN JUAN
State	:	PR
Zip	:	00926-5108
Country	:	US
Telephone Number	:	787-740-4740
Fax Number	:	787-269-6067

Provider Business Practice Location Address
First Line	:	BAYAMON MEDICAL PLZ
Second Line	:	SUITE 710
City	:	BAYAMON
State	:	PR
Zip	:	00959-7200
Country	:	US
Telephone Number	:	787-740-4740
Fax Number	:	787-269-6067

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

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	09/10/2014

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