Provider Demographics
NPI:1386853695
Name:LOPEZ, AIDA I (MD)
Entity Type:Individual
Prefix:DR
First Name:AIDA
Middle Name:I
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:PMB 75
Mailing Address - Street 2:P.O. BOX 70171
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8171
Mailing Address - Country:US
Mailing Address - Phone:787-793-5959
Mailing Address - Fax:
Practice Address - Street 1:1024 CALLE 3 S.E.
Practice Address - Street 2:URB. LA RIVIERA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3019
Practice Address - Country:US
Practice Address - Phone:787-793-5959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5482208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice