Provider Demographics
NPI:1588751317
Name:LOPEZ LOPEZ, PEDRO M
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:M
Last Name:LOPEZ LOPEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 URB PARQUE INTERAMERICANA
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784
Mailing Address - Country:US
Mailing Address - Phone:787-866-0730
Mailing Address - Fax:787-866-0747
Practice Address - Street 1:EDIFICIO COMMERCE PLAZA
Practice Address - Street 2:SUITE 205
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-866-0730
Practice Address - Fax:787-866-0747
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12976207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0089989OtherPTAN