Provider Demographics
NPI:1972822716
Name:LOPEZ COLON, AGNES LINNETTE (MD)
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:LINNETTE
Last Name:LOPEZ COLON
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:LA SERRANIA CALLE GARDENIA
Mailing Address - Street 2:108
Mailing Address - City:CAGUAS
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00725
Mailing Address - Country:UM
Mailing Address - Phone:787-636-2652
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL UPR, AVE. 65 DE INFANTERIA KM. 8.3
Practice Address - Street 2:PISO 1
Practice Address - City:CAROLINA
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00984
Practice Address - Country:UM
Practice Address - Phone:787-757-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14296207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine