Basic Information
| Provider Information | |||||||||
| NPI: | 1184680480 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRACIA-LOPEZ | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | URB. PASEO DE LA FUENTE | ||||||||
| Address2: | D-4 CALLE TIVOLI | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009266459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876417582 | ||||||||
| FaxNumber: | 7872927976 | ||||||||
| Practice Location | |||||||||
| Address1: | AVE. JOSE VAZQUEZ ESQ. DR. TROYER | ||||||||
| Address2: | NUCLEAR MEDICINE, MENNONITE GENERAL HOSPITAL | ||||||||
| City: | AIBONITO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007051379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877358001 | ||||||||
| FaxNumber: | 7872927976 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 08/02/2007 | ||||||||
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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 | 207R00000X | 7213 | PR | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207U00000X | 7213 | PR | Y | Allopathic & Osteopathic Physicians | Nuclear Medicine |
No ID Information.