1497894505 NPI number — DR. MAMIE ANNEXY LOPEZ MD

Table of content: DR. MAMIE ANNEXY LOPEZ MD (NPI 1497894505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497894505 NPI number — DR. MAMIE ANNEXY LOPEZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANNEXY LOPEZ
Provider First Name:
MAMIE
Provider Middle Name:
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:
ANNEXY LOPEZ
Provider Other First Name:
MAMIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1497894505
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1036
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANATI
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00674-1036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-884-5368
Provider Business Mailing Address Fax Number:
787-884-0881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
A4 CALLE MARGINAL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANATI
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00674-4903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-884-5368
Provider Business Practice Location Address Fax Number:
787-884-0881
Provider Enumeration Date:
02/05/2007

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: 207RG0100X , with the licence number:  9979 , 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: 4270 . This is a "IMC PROV. NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 600682 . This is a "MMM PROV. NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 82912AN . This is a "TRIPLE S PROV. #" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 214148 . This is a "PREFERRED HEALTH PROV. #" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 060032 . This is a "CRUZ AZUL PROV. NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1259A . This is a "PMC PROV. NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 7010026 . This is a "HUMANA PROV NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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