1316072721 NPI number — MS. CARMEN I LOPEZ GALARZA MD

Table of content: MS. CARMEN I LOPEZ GALARZA MD (NPI 1316072721)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316072721 NPI number — MS. CARMEN I LOPEZ GALARZA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOPEZ GALARZA
Provider First Name:
CARMEN I
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LOPEZ GALARZA
Provider Other First Name:
CARMEN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1316072721
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HIPOLAIS ST 962
Provider Second Line Business Mailing Address:
COUNTRY CLUB
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-768-3506
Provider Business Mailing Address Fax Number:
787-768-3506

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
INSTITUTS DE MEDICINE GENERAL Y ESPECIALIZADA
Provider Second Line Business Practice Location Address:
AVE ROBERTO CLEMENTE BLOQUE 30A10 VILLA CAROLINA
Provider Business Practice Location Address City Name:
CAROLINA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00985
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-757-0570
Provider Business Practice Location Address Fax Number:
787-757-0570
Provider Enumeration Date:
02/23/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  11094 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)