Provider Demographics
NPI:1134186778
Name:LOPEZ SUAREZ, JOSE AUGUSTO (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:AUGUSTO
Last Name:LOPEZ SUAREZ
Suffix:
Gender:M
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:PO BOX 29568 65TH INFANTRY STATION
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929
Mailing Address - Country:US
Mailing Address - Phone:787-754-7133
Mailing Address - Fax:787-754-7133
Practice Address - Street 1:CALLE ARIZMENDI #170
Practice Address - Street 2:#170
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00925
Practice Address - Country:US
Practice Address - Phone:787-754-7133
Practice Address - Fax:787-754-7133
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15153207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0022839Medicare ID - Type Unspecified
I24165Medicare UPIN