1144062670 NPI number — JOSE ALEJANDRO LOPEZ DIAZ M.D.

Table of content: JOSE ALEJANDRO LOPEZ DIAZ M.D. (NPI 1144062670)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144062670 NPI number — JOSE ALEJANDRO LOPEZ DIAZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOPEZ DIAZ
Provider First Name:
JOSE
Provider Middle Name:
ALEJANDRO
Provider Name Prefix Text:
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:
1144062670
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
01/16/2025
NPI Reactivation Date:
01/27/2025

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CELLE 12 Y CALLE RIO DE JANEIRO 0E3-313
Provider Second Line Business Mailing Address:
SAN JOSE DE MARIA CALDERON
Provider Business Mailing Address City Name:
QUITO
Provider Business Mailing Address State Name:
PIDINCHA
Provider Business Mailing Address Postal Code:
170204
Provider Business Mailing Address Country Code:
EC
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
234 E 149TH ST
Provider Second Line Business Practice Location Address:
BRONX, NY 10451
Provider Business Practice Location Address City Name:
THE BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
593-984-6251
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/06/2024

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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