Provider Demographics
NPI:1629374384
Name:LOPEZ, CARLOS I (PARAMEDIC/NURSE)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:I
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:PARAMEDIC/NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 6271
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-9619
Mailing Address - Country:US
Mailing Address - Phone:787-244-9518
Mailing Address - Fax:
Practice Address - Street 1:HC 1 BOX 6271
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-9619
Practice Address - Country:US
Practice Address - Phone:787-244-9518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2418-P146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2418-POtherSTATE LICENSE