Provider Demographics
NPI:1467470625
Name:FRIAS LOPEZ, JOSE MARIA
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:MARIA
Last Name:FRIAS LOPEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TOUS SOTO ST.
Mailing Address - Street 2:150 SOUTH
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754-0000
Mailing Address - Country:US
Mailing Address - Phone:787-736-3200
Mailing Address - Fax:787-736-3200
Practice Address - Street 1:TOUS SOTO ST.
Practice Address - Street 2:150 SOUTH
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754-0000
Practice Address - Country:US
Practice Address - Phone:787-736-3200
Practice Address - Fax:787-736-3200
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5211208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG06069Medicare UPIN
PR0026821Medicare ID - Type Unspecified