Basic Information
| Provider Information | |||||||||
| NPI: | 1275207953 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FUENTES- LOPEZ | ||||||||
| FirstName: | VICTOR | ||||||||
| MiddleName: | RAFAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | AU. D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | HC 44 BOX 12680 | ||||||||
| Address2: | |||||||||
| City: | CAYEY | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007369732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872052676 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | BO ARENA SECTOR CAMPO BELLO | ||||||||
| Address2: | CARR 734 KM 6.4 | ||||||||
| City: | CIDRA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007256254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877435054 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2021 | ||||||||
| LastUpdateDate: | 03/14/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 1021 | PR | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.