Provider Demographics
NPI:1326032657
Name:LOPEZ COMAS, MIRTA (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRTA
Middle Name:
Last Name:LOPEZ COMAS
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:PO BOX 9420
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-9420
Mailing Address - Country:US
Mailing Address - Phone:787-736-2252
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA MUNOZ RIVERA
Practice Address - Street 2:#7 NORTE
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754-0000
Practice Address - Country:US
Practice Address - Phone:787-736-2252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-01
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10251208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF18896Medicare UPIN