Basic Information
| Provider Information | |||||||||
| NPI: | 1265579759 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VIZCARRONDO | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | D9 CALLE GARDEN MDW | ||||||||
| Address2: | GARDEN HILLS | ||||||||
| City: | GUAYNABO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009662615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7873790414 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | LUIS MUNOZ MARIN AVE | ||||||||
| Address2: | URB MARIOLGA, HIMA | ||||||||
| City: | CAGUAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876533434 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 13340 | PR | Y | Other Service Providers | Specialist |
No ID Information.