Provider Demographics
NPI:1679686091
Name:LOPEZ DEL POZO, SERGIO R (MD)
Entity Type:Individual
Prefix:MR
First Name:SERGIO
Middle Name:R
Last Name:LOPEZ DEL POZO
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 1:8169 CALLE CONCORDIA
Mailing Address - Street 2:SUITE 312
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1563
Mailing Address - Country:US
Mailing Address - Phone:787-841-2777
Mailing Address - Fax:787-848-0007
Practice Address - Street 1:8169 CALLE CONCORDIA
Practice Address - Street 2:SUITE 312
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1563
Practice Address - Country:US
Practice Address - Phone:787-841-2777
Practice Address - Fax:787-848-0007
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7564207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0081480DOtherMEDICARE PRHC
0081479BOtherMEDICARE SHCE
29204Medicare ID - Type Unspecified
0081480DOtherMEDICARE PRHC