Provider Demographics
NPI:1477640530
Name:JUAN LOPEZ VELAQUEZ
Entity type:Organization
Organization Name:JUAN LOPEZ VELAQUEZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-836-7926
Mailing Address - Street 1:188 CALLE INVIERNO
Mailing Address - Street 2:BRISAS DEL GUAYANES
Mailing Address - City:PENUELAS
Mailing Address - State:PR
Mailing Address - Zip Code:00624-3012
Mailing Address - Country:US
Mailing Address - Phone:787-836-7926
Mailing Address - Fax:
Practice Address - Street 1:961 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:PENUELAS
Practice Address - State:PR
Practice Address - Zip Code:00624-1400
Practice Address - Country:US
Practice Address - Phone:787-836-7926
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1014291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
30795Medicare PIN