Provider Demographics
NPI:1326001413
Name:LOPEZ, CYNTHIA (MD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
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 1:130 WINSTON CHURCHILL AVE
Mailing Address - Street 2:PMB 356
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6018
Mailing Address - Country:US
Mailing Address - Phone:787-749-3000
Mailing Address - Fax:939-204-0984
Practice Address - Street 1:CALLE SERGIO PENA ALMODOVAR ESQUINA FLOR GERENA
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00792
Practice Address - Country:US
Practice Address - Phone:787-852-0665
Practice Address - Fax:787-850-1775
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16296208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice