Provider Demographics
NPI:1689663361
Name:ROSARIO LOPEZ, MARIBEL (MD)
Entity Type:Individual
Prefix:MISS
First Name:MARIBEL
Middle Name:
Last Name:ROSARIO 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:PO BOX 3893
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-3893
Mailing Address - Country:US
Mailing Address - Phone:787-895-6125
Mailing Address - Fax:787-895-6125
Practice Address - Street 1:CALLE CALIFORNIA B10
Practice Address - Street 2:
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678
Practice Address - Country:US
Practice Address - Phone:787-895-6125
Practice Address - Fax:787-895-6125
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR94102083X0100X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR81840R0OtherSSS
PR81840Medicare ID - Type Unspecified
E73864Medicare UPIN