Provider Demographics
NPI:1952347247
Name:PABON LOPEZ, MONSERRATE (MD)
Entity Type:Individual
Prefix:DR
First Name:MONSERRATE
Middle Name:
Last Name:PABON LOPEZ
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 2047
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-2047
Mailing Address - Country:US
Mailing Address - Phone:787-735-1471
Mailing Address - Fax:787-735-1635
Practice Address - Street 1:64 CALLE JOSE C VAZQUEZ
Practice Address - Street 2:
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-3308
Practice Address - Country:US
Practice Address - Phone:787-735-1471
Practice Address - Fax:787-735-1635
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5354207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR26552PAMedicare ID - Type Unspecified
PRC79550Medicare UPIN