Provider Demographics
NPI:1699805572
Name:LOPEZ-MALPICA, FERNANDO JUAN (MD)
Entity type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:JUAN
Last Name:LOPEZ-MALPICA
Suffix:
Gender:M
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:RIO PIEDRAS HEIGHTS
Mailing Address - Street 2:1728 CALLE SEGRE
Mailing Address - City:RIO PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00926-3257
Mailing Address - Country:US
Mailing Address - Phone:787-758-1621
Mailing Address - Fax:
Practice Address - Street 1:LOMAS VERDES CALLE S
Practice Address - Street 2:URB RIO PIEDRAS HEIGHTS
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00926-0001
Practice Address - Country:US
Practice Address - Phone:787-758-1621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4804207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0097280Medicare PIN
EO7196Medicare UPIN