Provider Demographics
NPI:1629062609
Name:LOPEZ MIERES, ADOLFO (MD)
Entity Type:Individual
Prefix:
First Name:ADOLFO
Middle Name:
Last Name:LOPEZ MIERES
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:COND CAMELOT
Mailing Address - Street 2:APT 4302 CARR 842
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-9760
Mailing Address - Country:US
Mailing Address - Phone:787-429-9211
Mailing Address - Fax:
Practice Address - Street 1:SAN JUAN CITY HOSPITAL
Practice Address - Street 2:MEDICAL CENTER
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00911
Practice Address - Country:US
Practice Address - Phone:787-765-5147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13883174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0020666Medicare ID - Type Unspecified