Provider Demographics
NPI:1376762179
Name:LOPEZ, JOEL OSVALDO (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:OSVALDO
Last Name:LOPEZ
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:PO BOX 3123
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-3123
Mailing Address - Country:US
Mailing Address - Phone:787-428-8228
Mailing Address - Fax:
Practice Address - Street 1:31 CALLE SAN BENITO
Practice Address - Street 2:
Practice Address - City:LAS MARIAS
Practice Address - State:PR
Practice Address - Zip Code:00670-2103
Practice Address - Country:US
Practice Address - Phone:787-827-0285
Practice Address - Fax:787-827-0285
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16683208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice