Provider Demographics
NPI:1215092028
Name:LOPEZ, CARMEN A (MD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:A
Last Name: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 1:1763 CALLE HORAS
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4837
Mailing Address - Country:US
Mailing Address - Phone:787-781-5440
Mailing Address - Fax:787-781-5077
Practice Address - Street 1:CARR. 21S-3 NUM.-2 LAS LOMAS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-781-5077
Practice Address - Fax:787-781-5077
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7842174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC82112Medicare UPIN
PR29297Medicare ID - Type UnspecifiedMEDICARE