Provider Demographics
NPI:1528251865
Name:LOPEZ DE LASALLE, ABIGAIL (MD)
Entity type:Individual
Prefix:DR
First Name:ABIGAIL
Middle Name:
Last Name:LOPEZ DE LASALLE
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 1:99 CALLE MANUEL CORCHADO JUARBE
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-2642
Mailing Address - Country:US
Mailing Address - Phone:787-609-6573
Mailing Address - Fax:787-609-6574
Practice Address - Street 1:99 CALLE MANUEL CORCHADO JUARBE
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-2642
Practice Address - Country:US
Practice Address - Phone:218-341-3347
Practice Address - Fax:787-609-6574
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15434208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice