Provider Demographics
NPI:1215901442
Name:THOMAS VISSEPO, ALEJANDRA (MD)
Entity type:Individual
Prefix:DR
First Name:ALEJANDRA
Middle Name:
Last Name:THOMAS VISSEPO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 CALLE 4 SE
Mailing Address - Street 2:CAPARRA TERRACE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-1734
Mailing Address - Country:US
Mailing Address - Phone:787-243-2984
Mailing Address - Fax:
Practice Address - Street 1:1151 CALLE 4 SE
Practice Address - Street 2:CAPARRA TERRACE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-1734
Practice Address - Country:US
Practice Address - Phone:787-243-2984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16327208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice