Provider Demographics
NPI:1710994611
Name:LOPEZ MUJICA, RICARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:
Last Name:LOPEZ MUJICA
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:PO BOX 1589
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-1589
Mailing Address - Country:US
Mailing Address - Phone:787-966-7500
Mailing Address - Fax:787-966-7505
Practice Address - Street 1:MARGINAL CARR 2 ESQUINA B
Practice Address - Street 2:SUITE G1 EXT.HERMANAS DAVILA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960
Practice Address - Country:US
Practice Address - Phone:787-966-7500
Practice Address - Fax:787-966-7505
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR64572085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD08486Medicare UPIN
PR28932Medicare ID - Type Unspecified