Provider Demographics
NPI:1063691616
Name:LOPEZ MOA, JOSE MIGUELANGEL (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:MIGUELANGEL
Last Name:LOPEZ MOA
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 1:1831 BLVD LUIS A FERRE
Mailing Address - Street 2:URB. SAN ANTONIO
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-1816
Mailing Address - Country:US
Mailing Address - Phone:787-243-8081
Mailing Address - Fax:
Practice Address - Street 1:1831 AVE LAS AMERICAS
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-1816
Practice Address - Country:US
Practice Address - Phone:787-243-8081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16897208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice