Provider Demographics
NPI:1952910465
Name:LOPEZ, JAIME DAVID (MD)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:DAVID
Last Name: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 1:7011 CALLE PEDRO NATER
Mailing Address - Street 2:BO. ALGARROBO
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-4737
Mailing Address - Country:US
Mailing Address - Phone:787-473-2341
Mailing Address - Fax:
Practice Address - Street 1:URB BRASILIA
Practice Address - Street 2:CARR 155 KM 0.5
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-855-2950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22384208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice