Provider Demographics
NPI:1912692435
Name:SANOGUET LOPEZ, VICTOR DANIEL
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:DANIEL
Last Name:SANOGUET LOPEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 703
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0703
Mailing Address - Country:US
Mailing Address - Phone:787-906-9823
Mailing Address - Fax:
Practice Address - Street 1:MANSIONES DE ESPANA MIGUEL DE CERVANTES #214
Practice Address - Street 2:MIGUEL DE CERVANTES
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-906-9823
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11025641367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered