Provider Demographics
NPI:1548226210
Name:SANTOYO LOPEZ, JESUS ALBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:ALBERTO
Last Name:SANTOYO LOPEZ
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:PO BOX 5174
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22194-5174
Mailing Address - Country:US
Mailing Address - Phone:703-490-3729
Mailing Address - Fax:703-499-9341
Practice Address - Street 1:12800 DARBY BROOK CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2487
Practice Address - Country:US
Practice Address - Phone:703-490-3729
Practice Address - Fax:703-499-9341
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101040852207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA046065OtherANTHEM BC/BS
VA046065OtherANTHEM BC/BS