Provider Demographics
NPI:1982939492
Name:MONTES LOPEZ, MARIDALIA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIDALIA
Middle Name:
Last Name:MONTES 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:PO BOX 2023
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737
Mailing Address - Country:US
Mailing Address - Phone:787-738-7302
Mailing Address - Fax:
Practice Address - Street 1:SAN JUAN BAUTISTA MEDICAL CENTER
Practice Address - Street 2:CARR 172 (SALIDA DE CAGUAS A CIDRA) URB. TURABO GARDENS
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-738-7302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17755208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice