Provider Demographics
NPI:1255314746
Name:LOPEZ, CARMEN (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:
Last Name: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:L1 CALLE 4 VILLAS DE RIO GRANDE
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-0000
Mailing Address - Country:US
Mailing Address - Phone:787-888-7336
Mailing Address - Fax:787-887-4045
Practice Address - Street 1:L1 CALLE 4
Practice Address - Street 2:VILLAS DE RIO GRANDE
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745-0000
Practice Address - Country:US
Practice Address - Phone:787-888-7336
Practice Address - Fax:787-887-4045
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9791208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR82361Medicare ID - Type Unspecified
PRF47569Medicare UPIN