1578591772 NPI number — DR. NYDIA M LOPEZ DIAZ M.D.

Table of content: DR. NYDIA M LOPEZ DIAZ M.D. (NPI 1578591772)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578591772 NPI number — DR. NYDIA M LOPEZ DIAZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOPEZ DIAZ
Provider First Name:
NYDIA
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578591772
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.M.B.235 2135 CARR.2
Provider Second Line Business Mailing Address:
SUITE 15
Provider Business Mailing Address City Name:
BAYAMON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00959
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-279-3297
Provider Business Mailing Address Fax Number:
787-279-3297

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR. 828 KM. 0.1
Provider Second Line Business Practice Location Address:
BARRIO PINAS
Provider Business Practice Location Address City Name:
TOA ALTA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00953-4611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-279-3297
Provider Business Practice Location Address Fax Number:
787-279-3297
Provider Enumeration Date:
06/28/2006

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: 174400000X , with the licence number:  11254 , 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)





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