1821047606 NPI number — DR. LUZ NEREIDA LOPEZ MD

Table of content: DR. LUZ NEREIDA LOPEZ MD (NPI 1821047606)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821047606 NPI number — DR. LUZ NEREIDA LOPEZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOPEZ
Provider First Name:
LUZ
Provider Middle Name:
NEREIDA
Provider Name Prefix Text:
DR.
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:
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:
1821047606
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
LOPEZ BONET MEDICAL CLINIC
Provider Second Line Business Mailing Address:
927 SANCHEZ VILELLA AVE., COUNTRY CLUB
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00924-3420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-757-6617
Provider Business Mailing Address Fax Number:
787-757-6617

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
LOPEZ BONET MEDICAL CLINIC
Provider Second Line Business Practice Location Address:
927 SANCHEZ VILELLA AVE., COUNTRY CLUB
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00924-3420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-757-6617
Provider Business Practice Location Address Fax Number:
787-757-6617
Provider Enumeration Date:
05/09/2006

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: 208D00000X , with the licence number:  9065 , 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)

  • Identifier: 060275 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 011-8419 . This is a "AACA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 201577 . This is a "PREFERRED HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 81921 . This is a "TRIPLES" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: PG2635 . This is a "PALIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 660522569009240000 . This is a "CHAMPUS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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