Provider Demographics
NPI:1336207224
Name:SANTOS LOPEZ, LUIS RAUL SR (MD)
Entity Type:Individual
Prefix:
First Name:LUIS RAUL
Middle Name:
Last Name:SANTOS LOPEZ
Suffix:SR
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:LOS MAESTROS 3
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:787-737-8338
Mailing Address - Fax:787-737-3191
Practice Address - Street 1:LOS MAESTROS 3
Practice Address - Street 2:DR SANTOS
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-737-8338
Practice Address - Fax:787-737-3191
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6175207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6175OtherLIC
AS1213848OtherDEA
PR6175OtherLIC
AS1213848OtherDEA