Provider Demographics
NPI:1003478546
Name:NIEVES LOPEZ PRIMARY MD PSC
Entity Type:Organization
Organization Name:NIEVES LOPEZ PRIMARY MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEVES LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-877-0244
Mailing Address - Street 1:PO BOX 192
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-0192
Mailing Address - Country:US
Mailing Address - Phone:787-877-0244
Mailing Address - Fax:787-551-7344
Practice Address - Street 1:69 CALLE PEDRO SANTOS SUITE 3
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-877-0244
Practice Address - Fax:787-551-7344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty