Provider Demographics
NPI:1093909996
Name:PEREZ-LOPEZ, SHIRLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:
Last Name:PEREZ-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 1:342 CAMINO DE LAS TRINITARIAS
Mailing Address - Street 2:URB VEREDAS
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-9687
Mailing Address - Country:US
Mailing Address - Phone:787-505-0648
Mailing Address - Fax:
Practice Address - Street 1:X2 AVE LUIS MUNOZ MARIN
Practice Address - Street 2:URB MARIOLGA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-746-4610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16866207QG0300X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR002-8163OtherPTAN