Provider Demographics
NPI:1194814640
Name:LOPEZ, MYRNA L (MD)
Entity Type:Individual
Prefix:DR
First Name:MYRNA
Middle Name:L
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 143554
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-3554
Mailing Address - Country:US
Mailing Address - Phone:787-879-4811
Mailing Address - Fax:787-879-4811
Practice Address - Street 1:65 AVE BARBOSA
Practice Address - Street 2:ARECIBO MEDICAL PLAZA, SUITE 102
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-2799
Practice Address - Country:US
Practice Address - Phone:787-879-4811
Practice Address - Fax:787-879-4811
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR10548207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR83395Medicare ID - Type UnspecifiedMEDICARE PROVIDER
PRF63047Medicare UPIN