Provider Demographics
NPI:1609872050
Name:LOPEZ, MARIA M (PED)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:M
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PED
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 9572
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-9572
Mailing Address - Country:US
Mailing Address - Phone:787-714-4983
Mailing Address - Fax:787-714-4983
Practice Address - Street 1:12 CALLE BARCELO
Practice Address - Street 2:
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-3446
Practice Address - Country:US
Practice Address - Phone:787-714-4983
Practice Address - Fax:787-714-4983
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10931208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics