1487650164 NPI number — DR. TEODORO LOPEZ RIVERA D.M.D., MSCD.

Table of content: DR. TEODORO LOPEZ RIVERA D.M.D., MSCD. (NPI 1487650164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487650164 NPI number — DR. TEODORO LOPEZ RIVERA D.M.D., MSCD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOPEZ RIVERA
Provider First Name:
TEODORO
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.M.D., MSCD.
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:
1487650164
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 330707
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00733-0707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-844-1880
Provider Business Mailing Address Fax Number:
787-844-5885

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EDIFICIO CLAUSELLS 129 CALLE VILLA
Provider Second Line Business Practice Location Address:
SUITE 24
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-844-1880
Provider Business Practice Location Address Fax Number:
787-844-5885
Provider Enumeration Date:
06/27/2005

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: 1223P0221X , with the licence number:  728 , 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: 040471 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 237025 . This is a "UTI" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 4722 . This is a "INTERNATIONAL MEDICAL CAR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 40719 . This is a "SEGUROS SERVICIOS SALUD" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 7310173 . This is a "HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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