Provider Demographics
NPI:1881742021
Name:LOPEZ CASTRO, LUIS ALBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ALBERTO
Last Name:LOPEZ CASTRO
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 7670
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7670
Mailing Address - Country:US
Mailing Address - Phone:787-841-7194
Mailing Address - Fax:787-841-7194
Practice Address - Street 1:3047 AVE EMILIO FAGOT
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4115
Practice Address - Country:US
Practice Address - Phone:787-841-7194
Practice Address - Fax:787-841-7194
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10856208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR10856OtherSTATE LICENCE
PR10856OtherSTATE LICENCE
PR083034Medicare ID - Type UnspecifiedMEDICARE ID NUMBER