Provider Demographics
NPI:1891710802
Name:LOPEZ-ENRIQUEZ, EDRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:EDRICK
Middle Name:
Last Name:LOPEZ-ENRIQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:EDRICK
Other - Middle Name:
Other - Last Name:LOPEZ-ENRIQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:160 CALLE MENDEZ VIGO E
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-5048
Mailing Address - Country:US
Mailing Address - Phone:787-832-8574
Mailing Address - Fax:787-832-8574
Practice Address - Street 1:160 CALLE MENDEZ VIGO E
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-5048
Practice Address - Country:US
Practice Address - Phone:787-832-8574
Practice Address - Fax:787-832-8574
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4718207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0025618Medicare PIN
PRD32938Medicare UPIN