Provider Demographics
NPI:1093848129
Name:LOPEZ BERRIOS, JUAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:
Last Name:LOPEZ BERRIOS
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 3314
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-3314
Mailing Address - Country:US
Mailing Address - Phone:787-767-8208
Mailing Address - Fax:787-758-6640
Practice Address - Street 1:CENTRO COMERCIAL LOS FLAMBOYANES
Practice Address - Street 2:LOCAL 9 AVE 65 DE INFANTERIA
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00923
Practice Address - Country:US
Practice Address - Phone:787-767-8208
Practice Address - Fax:787-758-6640
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3912174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0095374Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
PRD08676Medicare UPIN