Provider Demographics
NPI:1578595385
Name:DIAZ LOPEZ, HECTOR IVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:HECTOR
Middle Name:IVAN
Last Name:DIAZ 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 801235
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-1235
Mailing Address - Country:US
Mailing Address - Phone:787-840-0384
Mailing Address - Fax:787-840-0384
Practice Address - Street 1:TORRE SAN CRISTOBAL
Practice Address - Street 2:SUITE 406
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780
Practice Address - Country:US
Practice Address - Phone:787-840-0384
Practice Address - Fax:787-840-0384
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR011555207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI-50116Medicare UPIN
PR0022223Medicare ID - Type Unspecified