Provider Demographics
NPI:1649361395
Name:LOPEZ, CARMEN E (MD)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:E
Last Name:LOPEZ
Suffix:
Gender:F
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:P O BOX 360396
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-0396
Mailing Address - Country:US
Mailing Address - Phone:787-767-7370
Mailing Address - Fax:
Practice Address - Street 1:AVE WISTON CHURCHILL 124
Practice Address - Street 2:ESQ PARANA 3ER PISO OFC 10
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-767-7370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6074208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR27657Medicare ID - Type Unspecified