Provider Demographics
NPI:1093702524
Name:RUIZ-LOPEZ, ROBERTO (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:
Last Name:RUIZ-LOPEZ
Suffix:
Gender:M
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:PO BOX 194800
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-4300
Mailing Address - Country:US
Mailing Address - Phone:787-751-8286
Mailing Address - Fax:787-751-8286
Practice Address - Street 1:1394 CALLE SAN RAFAEL
Practice Address - Street 2:OFICINA 10
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2541
Practice Address - Country:US
Practice Address - Phone:787-751-8286
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8619207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR29877Medicare ID - Type Unspecified
C77717Medicare UPIN