Provider Demographics
NPI:1770624116
Name:LOPEZ GALARZA, LUIS ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ANTONIO
Last Name:LOPEZ GALARZA
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:PO BOX 1069
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-1069
Mailing Address - Country:US
Mailing Address - Phone:787-884-6195
Mailing Address - Fax:787-884-6195
Practice Address - Street 1:EDIFICIO PEDRO BLANCO LUGO 200
Practice Address - Street 2:SUITE 204
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-884-4744
Practice Address - Fax:787-621-3319
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6725208600000X
AZ199392086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Not Answered2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR28414OtherTRIPLE S
PR3580OtherPREFFERED MEDICARE CHOICE
PR990881OtherMEDICARE Y MUCHO MAS
PR28414Medicaid
PR28414Medicare ID - Type Unspecified
PR28414Medicaid