Provider Demographics
NPI:1417025248
Name:LOPEZ, HUGO J (LIC AC)
Entity Type:Individual
Prefix:
First Name:HUGO
Middle Name:J
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 NEWPORT ST
Mailing Address - Street 2:APT. NO. 3
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02125-1224
Mailing Address - Country:US
Mailing Address - Phone:617-927-6296
Mailing Address - Fax:
Practice Address - Street 1:FENWAY COMM. HEALTH
Practice Address - Street 2:7 HAVILAND STREET
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-927-6296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA564171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist