Provider Demographics
NPI:1386765493
Name:LOPEZ, DAISY MARY (MD)
Entity type:Individual
Prefix:DR
First Name:DAISY
Middle Name:MARY
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 1:202 CALLE RAMOS ANTONINI E
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-4636
Mailing Address - Country:US
Mailing Address - Phone:787-833-8166
Mailing Address - Fax:787-834-1824
Practice Address - Street 1:202 CALLE RAMOS ANTONINI E
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4636
Practice Address - Country:US
Practice Address - Phone:787-833-8166
Practice Address - Fax:787-834-1824
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10411174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR89427Medicare ID - Type Unspecified
PRE81911Medicare UPIN