1093791626 NPI number — DR. RAFAEL AUGUSTO LOPEZ-TORRES M.D.

Table of content: DR. RAFAEL AUGUSTO LOPEZ-TORRES M.D. (NPI 1093791626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093791626 NPI number — DR. RAFAEL AUGUSTO LOPEZ-TORRES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOPEZ-TORRES
Provider First Name:
RAFAEL
Provider Middle Name:
AUGUSTO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1093791626
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 194000
Provider Second Line Business Mailing Address:
PMB 285
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00919-4000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-638-2853
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BARRIO RINCON, SECTOR LOMAS, CARRETERA 13, KM 12.0
Provider Second Line Business Practice Location Address:
ANESTHESIA OFFICE, 3RD FLOOR
Provider Business Practice Location Address City Name:
CAYEY
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-638-2853
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2005

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: 207L00000X , with the licence number:  14165 , 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: 21139LO . This is a "ANESTHESIOLOGY" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 2-1139 , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".