Provider Demographics
NPI:1407815749
Name:LOPEZ, ROCELA JUANA GREGORIO (MD)
Entity Type:Individual
Prefix:
First Name:ROCELA JUANA
Middle Name:GREGORIO
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 1:3 WHITWICK COURT
Mailing Address - Street 2:
Mailing Address - City:CARNEY
Mailing Address - State:MD
Mailing Address - Zip Code:21234
Mailing Address - Country:US
Mailing Address - Phone:410-668-3344
Mailing Address - Fax:
Practice Address - Street 1:3 WHITWICK COURT
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234
Practice Address - Country:US
Practice Address - Phone:141-066-8334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0062389207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG64829Medicare UPIN
MD089LK561Medicare ID - Type Unspecified