Provider Demographics
NPI:1447427240
Name:LOPERENA, IVAN (PROPIETARY)
Entity Type:Individual
Prefix:MR
First Name:IVAN
Middle Name:
Last Name:LOPERENA
Suffix:
Gender:M
Credentials:PROPIETARY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 URB CRISTAL
Mailing Address - Street 2:BO CORRALES
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-6306
Mailing Address - Country:US
Mailing Address - Phone:787-882-5915
Mailing Address - Fax:
Practice Address - Street 1:68 URB CRISTAL
Practice Address - Street 2:BO CORRALES
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-6306
Practice Address - Country:US
Practice Address - Phone:787-882-5915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1094171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR20458OtherPMC MEDICARE CHOICE
PR660561350OtherMCS REFORMA
PR660561350OtherHUMANA GOLD PLUS
PR660561350OtherMEDICAL CARD SYSTEM
PR660561350OtherTRICARE STANDER
PR31489OtherMEDICARE SELECTO
PR660561350OtherHUMANA GOLD CHOICE
PR660561350OtherCOSVI MEDICARE
PR31489OtherTRIPLE SSS
PR660561350OtherMEDICARE EXCELL
PR660561350OtherMCS CLASSICARE
PR660561350OtherTRICARE PRIME
PR660561350OtherINTERNATIONAL MEDICAL CARD
PR1053383216OtherSAL;UD DORADA MEDICARE
PR31489OtherMEDICARE OPTIMO
PR31489Medicaid
PR6030092OtherHUMANA INSURANCE
PR660561350OtherFIRST PLUS
PR20526OtherAMERICAN HEALTH