Provider Demographics
NPI:1558363648
Name:LOPEZ-MARTINEZ, RICARDO ANDRES (MD,FACS)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:ANDRES
Last Name:LOPEZ-MARTINEZ
Suffix:
Gender:M
Credentials:MD,FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:INST SAN PABLO STE 406
Mailing Address - Street 2:CALLE SANTA CRUZ # 66
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-269-3355
Mailing Address - Fax:787-269-3377
Practice Address - Street 1:INST SAN PABLO STE 406
Practice Address - Street 2:CALLE SANTA CRUZ # 66
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-269-3355
Practice Address - Fax:787-269-3377
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-02
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10732208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR9590021OtherHUMANA
PR88451OtherSSS
PRG40993Medicare UPIN
PR88451OtherSSS