Provider Demographics
NPI:1407855372
Name:LOPEZ, JOSE LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:LUIS
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PASEO DEL SOL
Mailing Address - Street 2:209 CALLE METIS
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-4618
Mailing Address - Country:US
Mailing Address - Phone:787-405-6346
Mailing Address - Fax:787-278-8494
Practice Address - Street 1:SARDINERA BEACH BUILDING, URB. COSTA DE ORO, C/MARGINAL
Practice Address - Street 2:SUITE 3
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-2055
Practice Address - Country:US
Practice Address - Phone:787-278-3636
Practice Address - Fax:787-278-8494
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2024-02-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR13112207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0090264Medicare ID - Type Unspecified
PRH01594Medicare UPIN