Provider Demographics
NPI:1316099864
Name:LOPEZ DAVILA, LIANA E (MD)
Entity type:Individual
Prefix:
First Name:LIANA
Middle Name:E
Last Name:LOPEZ DAVILA
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 364443
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-4443
Mailing Address - Country:US
Mailing Address - Phone:787-759-7878
Mailing Address - Fax:787-756-8934
Practice Address - Street 1:JOSE MARTI #56 FLORAL PARK
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-759-7878
Practice Address - Fax:787-756-8934
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR121752085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G40924Medicare UPIN
PR0089191Medicare ID - Type Unspecified