Provider Demographics
NPI:1023139052
Name:GONZALEZ LOPEZ INC
Entity type:Organization
Organization Name:GONZALEZ LOPEZ INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:J
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-738-9900
Mailing Address - Street 1:PO BOX 372140
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-2140
Mailing Address - Country:US
Mailing Address - Phone:787-738-9595
Mailing Address - Fax:787-738-1414
Practice Address - Street 1:CALLE CARRION MADURO
Practice Address - Street 2:#54 SUR
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-738-9595
Practice Address - Fax:787-738-1414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR30259Medicare ID - Type Unspecified