Provider Demographics
NPI:1881682730
Name:LOPEZ RUIZ, ANGEL LUIS (MD)
Entity Type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:LUIS
Last Name:LOPEZ RUIZ
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 1:29 WASHINGTON ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1509
Mailing Address - Country:US
Mailing Address - Phone:787-722-6795
Mailing Address - Fax:787-723-1205
Practice Address - Street 1:29 WASHINGTON ST
Practice Address - Street 2:SUITE 205
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1509
Practice Address - Country:US
Practice Address - Phone:787-722-6795
Practice Address - Fax:787-723-1205
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6996174400000X
PR006996208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE24345Medicare UPIN
PR0098508Medicare ID - Type UnspecifiedPROVIDER NUMBER MEDICARE