Provider Demographics
NPI:1477174217
Name:LOPES, JORGE LUIS SR (MA)
Entity Type:Individual
Prefix:PROF
First Name:JORGE
Middle Name:LUIS
Last Name:LOPES
Suffix:SR
Gender:M
Credentials:MA
Other - Prefix:PROF
Other - First Name:JORGE
Other - Middle Name:LUIS
Other - Last Name:LOPES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTER NURSE
Mailing Address - Street 1:100 CALLE ALONDRA UNIT 30275
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-3013
Mailing Address - Country:US
Mailing Address - Phone:939-402-6482
Mailing Address - Fax:
Practice Address - Street 1:100 CALLE ALONDRA UNIT 30275
Practice Address - Street 2:405 DIEZ DE ANDINO STREET STOP 25 SANTURCE PR 00912
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00929-3013
Practice Address - Country:US
Practice Address - Phone:939-402-6482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR36982163WC1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR36982GOtherNURSE LICENCE