1235325846 NPI number — ALBERTO T LOPEZ

Table of content: (NPI 1235325846)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235325846 NPI number — ALBERTO T LOPEZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALBERTO T LOPEZ
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1235325846
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 19707
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00910-1707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-751-2277
Provider Business Mailing Address Fax Number:
787-751-2278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
NATIONAL PLAZA 431 PONCE DE LEON
Provider Second Line Business Practice Location Address:
SUITE 900
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-751-2277
Provider Business Practice Location Address Fax Number:
787-751-2278
Provider Enumeration Date:
09/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LOPEZ-ENRIQUEZ
Authorized Official First Name:
ALBERTO
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
787-751-2277

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  6707 , 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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