Provider Demographics
NPI:1235181017
Name:LOPEZ-RODRIGUEZ, JORGE L (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:L
Last Name:LOPEZ-RODRIGUEZ
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:URB PACIFICA PG 43
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-6150
Mailing Address - Country:US
Mailing Address - Phone:787-722-2251
Mailing Address - Fax:787-722-2292
Practice Address - Street 1:CALLE H PODNOMO
Practice Address - Street 2:ESQ LAS PALMAS
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00908
Practice Address - Country:US
Practice Address - Phone:787-721-8330
Practice Address - Fax:787-722-2292
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11397207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR80134Medicare ID - Type Unspecified
G41063Medicare UPIN