Provider Demographics
NPI:1194538413
Name:LOPEZ, RAFAEL EDUARDO (DC)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:EDUARDO
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:DC
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 1567
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-1567
Mailing Address - Country:US
Mailing Address - Phone:787-487-7474
Mailing Address - Fax:
Practice Address - Street 1:BO LA ENVIDIADA CARR 106 R 356 KM 1 INT
Practice Address - Street 2:FINCA LOS TRES HERMANOS
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-487-7474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1014111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor