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NPI Code Detail

MEDICARE: DR. JOSE MIGUELANGEL LOPEZ MOA M.D.

MEDICARE:  DR. JOSE MIGUELANGEL LOPEZ MOA  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208D00000XGeneral Practice Physician16897PR

General Provider Information

NPI Number : 1063691616
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOSE MIGUELANGEL LOPEZ MOA M.D.
Provider Business Mailing Address
First Line : 1831 BLVD LUIS A FERRE
Second Line : URB. SAN ANTONIO
City : PONCE
State : PR
Zip : 00728-1816
Country : US
Telephone Number : 787-243-8081
Fax Number :
Provider Business Practice Location Address
First Line : 1831 AVE LAS AMERICAS
Second Line :
City : PONCE
State : PR
Zip : 00728-1816
Country : US
Telephone Number : 787-243-8081
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2007
Last Update Date : 04/27/2015

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Directions to “ DR. JOSE MIGUELANGEL LOPEZ MOA M.D.” Practice Location

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