Provider Demographics
NPI:1629167432
Name:PEREZ LOPEZ, ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:PEREZ LOPEZ
Suffix:
Gender:F
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:E-9 CALLE DILDO
Mailing Address - Street 2:ALTURAS DE SANTA MARIA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4707
Mailing Address - Country:US
Mailing Address - Phone:787-382-2072
Mailing Address - Fax:787-287-1282
Practice Address - Street 1:AVE. PARANA #1667
Practice Address - Street 2:RIO PIEDRAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:787-247-5223
Practice Address - Fax:787-287-1282
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16584208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI-73066Medicare UPIN