Provider Demographics
NPI:1548749757
Name:LOPEZ RIVERA, JOSE ENRIQUE (BSN/RN)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ENRIQUE
Last Name:LOPEZ RIVERA
Suffix:
Gender:M
Credentials:BSN/RN
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 370814
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-0814
Mailing Address - Country:US
Mailing Address - Phone:787-557-0478
Mailing Address - Fax:
Practice Address - Street 1:CONSOLIDATED MALL B5
Practice Address - Street 2:202 AVE GAUTIER BENITEZ
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00726-0000
Practice Address - Country:US
Practice Address - Phone:787-704-0705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR86976163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0080025105659Medicaid