Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 15691 | PR |
NPI | 1013995018 |
---|---|
Provider Name | Dr. Vionette D Lopez |
First Address | Camuy, PR 00627-9716 |
Second Address | Camuy, PR 00627-9600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2006 |
Last Update Date | 25/08/2015 |