Provider Demographics
NPI:1265461743
Name:LOPEZ, ANGELES CASAS (MD)
Entity Type:Individual
Prefix:
First Name:ANGELES
Middle Name:CASAS
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:CALLE LAS MERCEDES #23
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-1943
Mailing Address - Country:US
Mailing Address - Phone:787-859-6402
Mailing Address - Fax:787-859-9028
Practice Address - Street 1:23 CALLE LAS MERCEDES
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-2077
Practice Address - Country:US
Practice Address - Phone:787-859-6402
Practice Address - Fax:787-859-9028
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5759208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8046Medicare UPIN