Provider Demographics
NPI:1487041596
Name:LOPEZ VEGA, KEYSHA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:KEYSHA
Middle Name:MARIE
Last Name:LOPEZ VEGA
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 1:1033 CALLE CERRO SALIENTE
Mailing Address - Street 2:URB. QUINTAS DE ALTAMIRA
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-9107
Mailing Address - Country:US
Mailing Address - Phone:787-316-3753
Mailing Address - Fax:
Practice Address - Street 1:155 AVE ARTERIAL HOSTOS APT 222
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2938
Practice Address - Country:US
Practice Address - Phone:787-316-3753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-16
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21131207R00000X, 207RN0300X
COTL.0008177390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty