Provider Demographics
NPI:1598749483
Name:LOPEZ, JOSE JOAQUIN (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:JOAQUIN
Last Name: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 909
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-0909
Mailing Address - Country:US
Mailing Address - Phone:787-863-1230
Mailing Address - Fax:787-863-1230
Practice Address - Street 1:5Z30 CALLE 5-20
Practice Address - Street 2:URB. JARDINES MONTEBRISAS
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-3911
Practice Address - Country:US
Practice Address - Phone:787-648-8148
Practice Address - Fax:787-655-2323
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-03
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11386207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH82244Medicare UPIN