Provider Demographics
NPI:1316072721
Name:LOPEZ GALARZA, CARMEN I (MD)
Entity type:Individual
Prefix:MS
First Name:CARMEN I
Middle Name:
Last Name:LOPEZ GALARZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:
Other - Last Name:LOPEZ GALARZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:HIPOLAIS ST 962
Mailing Address - Street 2:COUNTRY CLUB
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924
Mailing Address - Country:US
Mailing Address - Phone:787-768-3506
Mailing Address - Fax:787-768-3506
Practice Address - Street 1:INSTITUTS DE MEDICINE GENERAL Y ESPECIALIZADA
Practice Address - Street 2:AVE ROBERTO CLEMENTE BLOQUE 30A10 VILLA CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-757-0570
Practice Address - Fax:787-757-0570
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11094208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
G04570Medicare ID - Type Unspecified
83649Medicare UPIN