Provider Demographics
NPI:1376781690
Name:LOPEZ VIDAL, HERNAN (DC)
Entity Type:Individual
Prefix:DR
First Name:HERNAN
Middle Name:
Last Name:LOPEZ VIDAL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PLAZA REAL SHOPPING CENTER
Mailing Address - Street 2:SUITE 307
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00965
Mailing Address - Country:US
Mailing Address - Phone:787-999-6570
Mailing Address - Fax:787-999-6571
Practice Address - Street 1:PLAZA REAL SHOPPING CENTER
Practice Address - Street 2:SUITE 307
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00965
Practice Address - Country:US
Practice Address - Phone:787-999-6570
Practice Address - Fax:787-999-6571
Is Sole Proprietor?:No
Enumeration Date:2009-01-23
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR448111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor