Provider Demographics
NPI:1821192386
Name:DAVILA-LOPES, JUAN ANTONIO (MD)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:ANTONIO
Last Name:DAVILA-LOPES
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 722
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-0722
Mailing Address - Country:US
Mailing Address - Phone:787-864-1475
Mailing Address - Fax:787-864-1470
Practice Address - Street 1:46 CALLE VICENTE PALES OESTE
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-4851
Practice Address - Country:US
Practice Address - Phone:787-864-1475
Practice Address - Fax:787-864-1470
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7015207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR400037OtherMMM
PR068715OtherBLUE CROSS
PR28570OtherBLUE SHIELD SSS
PR068715OtherBLUE CROSS
PR400037OtherMMM