Provider Demographics
NPI:1861670077
Name:LOPEZ, ELBA AIXA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELBA
Middle Name:AIXA
Last Name: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 1:66 VIA MIRADERO
Mailing Address - Street 2:URB. SANJUANERA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-3095
Mailing Address - Country:US
Mailing Address - Phone:787-368-3345
Mailing Address - Fax:
Practice Address - Street 1:#47 CALLE CORCHADO
Practice Address - Street 2:ESQUINA RUIZ BELVIS
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-746-3606
Practice Address - Fax:787-744-2508
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17014208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice