Provider Demographics
NPI:1386842342
Name:LOPEZ-ORTIZ, HECTOR LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:HECTOR
Middle Name:LUIS
Last Name:LOPEZ-ORTIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HECTOR
Other - Middle Name:LUIS
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1092 HAMPSTEAD PL
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-6200
Mailing Address - Country:US
Mailing Address - Phone:787-557-6225
Mailing Address - Fax:
Practice Address - Street 1:501 GARY HILL RD
Practice Address - Street 2:
Practice Address - City:EDGEFIELD
Practice Address - State:SC
Practice Address - Zip Code:29824-4503
Practice Address - Country:US
Practice Address - Phone:803-637-1444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15129208D00000X
FLACN 200208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice