Provider Demographics
NPI:1992972459
Name:LOPEZ-VEGA, JOEL JOSUE (MD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:JOSUE
Last Name:LOPEZ-VEGA
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:HC 07 BOX 38931
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-9466
Mailing Address - Country:US
Mailing Address - Phone:787-890-0789
Mailing Address - Fax:787-890-0789
Practice Address - Street 1:CARR 110 KM 3.6 BO. ARENALES SECTOR LA CHARCA
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-9466
Practice Address - Country:US
Practice Address - Phone:787-890-0789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17153208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice