Provider Demographics
NPI:1114990611
Name:LOPEZ BURREZO, JOSE JAVIER (M D)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:JAVIER
Last Name:LOPEZ BURREZO
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 CALLE WEST ROSE
Mailing Address - Street 2:URB. CIUDAD JARDIN
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-2222
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:277 CALLE SAN JORGE
Practice Address - Street 2:SAN JORGE MEDICAL OFFICE BLDG SUITE 406
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912-3331
Practice Address - Country:US
Practice Address - Phone:787-726-0210
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12373208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics