Provider Demographics
NPI:1477518173
Name:LOPEZ-GUZMAN, EVA IRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:EVA
Middle Name:IRIS
Last Name:LOPEZ-GUZMAN
Suffix:
Gender:F
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:PO BOX 960
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669
Mailing Address - Country:US
Mailing Address - Phone:787-897-3577
Mailing Address - Fax:787-897-2725
Practice Address - Street 1:BARRIO PILETAS CARR. 453 KM. 5.1 INT.
Practice Address - Street 2:
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669-0960
Practice Address - Country:US
Practice Address - Phone:787-897-8481
Practice Address - Fax:787-897-8481
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5947208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR27043Medicaid
D08388Medicare UPIN
27043Medicare ID - Type Unspecified