Provider Demographics
NPI:1609534841
Name:LOPEZ BAQUERO, LUIS MANUEL (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:MANUEL
Last Name:LOPEZ BAQUERO
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:URB EL TORITO CALLE 6 D 32
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-4826
Mailing Address - Country:US
Mailing Address - Phone:762-240-8909
Mailing Address - Fax:
Practice Address - Street 1:URB EL TORITO CALLE 6 D 32
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-4826
Practice Address - Country:US
Practice Address - Phone:762-240-8909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-06
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15809I208D00000X
PR22907208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice