Provider Demographics
NPI:1134787708
Name:LOPEZ PEREZ, ANGEL LUIS (MD)
Entity type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:LUIS
Last Name:LOPEZ PEREZ
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:M12 CALLE 12
Mailing Address - Street 2:URB VERSALLES
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-297-5371
Mailing Address - Fax:
Practice Address - Street 1:M12 CALLE 12
Practice Address - Street 2:URB VERSALLES
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-2123
Practice Address - Country:US
Practice Address - Phone:787-297-5371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-30
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21368208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice