Provider Demographics
NPI:1386722320
Name:MARIA J LOPEZ AGUADO
Entity type:Organization
Organization Name:MARIA J LOPEZ AGUADO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOPEZ AGUADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-837-0556
Mailing Address - Street 1:PO BOX 518
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-0518
Mailing Address - Country:US
Mailing Address - Phone:787-837-0556
Mailing Address - Fax:787-837-5279
Practice Address - Street 1:104 CALLE COMERCIO
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-1645
Practice Address - Country:US
Practice Address - Phone:787-837-0556
Practice Address - Fax:787-837-5279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR341291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0030839Medicare PIN