Provider Demographics
NPI:1013468974
Name:LOPEZ, CARLOS A (CPHT)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:A
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:A3 CALLE MONFORTE
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-2501
Mailing Address - Country:US
Mailing Address - Phone:787-696-4849
Mailing Address - Fax:
Practice Address - Street 1:COND AMERICAS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2152
Practice Address - Country:US
Practice Address - Phone:787-474-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8537281PC2000X, 282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281PC2000XHospitalsChronic Disease HospitalChildren
No282NC2000XHospitalsGeneral Acute Care HospitalChildren