Provider Demographics
NPI:1548338700
Name:LOPEZ DEL POZO, LUIS ERNESTO (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ERNESTO
Last Name:LOPEZ DEL POZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:CALLE CONCORDIA 8169 SUITE 5
Mailing Address - Street 2:CONDOMINIO SAN VICENTE
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1555
Mailing Address - Country:US
Mailing Address - Phone:787-290-2195
Mailing Address - Fax:787-290-2195
Practice Address - Street 1:CALLE CONCORDIA 8169 SUITE 5
Practice Address - Street 2:CONDOMINIO SAN VICENTE
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1555
Practice Address - Country:US
Practice Address - Phone:787-290-2195
Practice Address - Fax:787-290-2195
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR13931208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
0021348Medicare ID - Type Unspecified
H80174Medicare UPIN