Provider Demographics
NPI:1982645115
Name:LOPEZ, FANNY RUBI (MD)
Entity Type:Individual
Prefix:DR
First Name:FANNY
Middle Name:RUBI
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8068
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-8068
Mailing Address - Country:US
Mailing Address - Phone:787-892-2040
Mailing Address - Fax:787-892-2040
Practice Address - Street 1:187 CALLE LUNA
Practice Address - Street 2:RALI BUILDING SUITE 205
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-4481
Practice Address - Country:US
Practice Address - Phone:787-892-2040
Practice Address - Fax:787-892-2040
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9837208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics