Provider Demographics
NPI:1043314388
Name:LOPEZ, ADRY FERNANDEZ (MD)
Entity Type:Individual
Prefix:
First Name:ADRY
Middle Name:FERNANDEZ
Last Name:LOPEZ
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 1:359 AVE DE DIEGO
Mailing Address - Street 2:SUITE301
Mailing Address - City:SANTURCE
Mailing Address - State:PR
Mailing Address - Zip Code:00909-1739
Mailing Address - Country:US
Mailing Address - Phone:787-725-8380
Mailing Address - Fax:787-725-8382
Practice Address - Street 1:359 AVE DE DIEGO
Practice Address - Street 2:SUITE301
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909-1739
Practice Address - Country:US
Practice Address - Phone:787-725-8380
Practice Address - Fax:787-725-8382
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR006427261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR88028OtherTRIPLESSSPUERTORICO
PR068315OtherCRUZAZULDEPUERTORICO
PR0028158Medicare ID - Type Unspecified
PRE08534Medicare UPIN