Provider Demographics
NPI:1477025591
Name:LOPEZ PEREZ, LUIS ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ANTONIO
Last Name:LOPEZ PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:592 CALLE CESAR GONZALEZ APT 711
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3957
Mailing Address - Country:US
Mailing Address - Phone:787-515-7316
Mailing Address - Fax:
Practice Address - Street 1:CARR #2 KM 47.7
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-4700
Practice Address - Country:US
Practice Address - Phone:787-621-3322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-31
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21690208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice