Provider Demographics
NPI:1356548572
Name:PRIMARY CARE AND WEIGHT LOSS CENTER
Entity type:Organization
Organization Name:PRIMARY CARE AND WEIGHT LOSS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DUENO
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ DEL POZO
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICO
Authorized Official - Phone:787-290-2195
Mailing Address - Street 1:CONDOMINIO SAN VICENTE
Mailing Address - Street 2:8169 CALLE CONCORDIA SUITE 5
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1555
Mailing Address - Country:US
Mailing Address - Phone:787-290-2195
Mailing Address - Fax:787-290-2195
Practice Address - Street 1:CONDOMINIO SAN VICENTE
Practice Address - Street 2:8169 CALLE CONCORDIA SUITE 5
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1555
Practice Address - Country:US
Practice Address - Phone:787-290-2195
Practice Address - Fax:787-290-2195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13931208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0021348Medicare ID - Type UnspecifiedMEDICO GENERALISTA