Provider Demographics
NPI:1528221090
Name:LOPEZ, DORALICE (MD)
Entity Type:Individual
Prefix:
First Name:DORALICE
Middle Name:
Last Name:LOPEZ
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:AA10 CAMINO PANORAMICO
Mailing Address - Street 2:ALTAVILLA URB.ENCANTADA
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-6088
Mailing Address - Country:US
Mailing Address - Phone:787-755-4437
Mailing Address - Fax:787-755-4437
Practice Address - Street 1:AA10 CAMINO PANORAMICO
Practice Address - Street 2:ALTAVILLA URB.ENCANTADA
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-6088
Practice Address - Country:US
Practice Address - Phone:787-755-4437
Practice Address - Fax:787-755-4437
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-05
Last Update Date:2008-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12525202C00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner