Provider Demographics
NPI:1831289982
Name:LOPEZ, ULISES (MD)
Entity Type:Individual
Prefix:DR
First Name:ULISES
Middle Name:
Last Name:LOPEZ
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 524
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-0524
Mailing Address - Country:US
Mailing Address - Phone:787-270-5424
Mailing Address - Fax:787-270-0165
Practice Address - Street 1:CARIBE MEDICAL PLAZA MARGINAL SANTA RITA
Practice Address - Street 2:SUITE 206
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-727-0542
Practice Address - Fax:787-270-0165
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6468207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0027972Medicare ID - Type UnspecifiedPROVIDER NUMBER