MEDICARE: DR. JOSE LUIS LOPEZ 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
1	207QG0300X	Geriatric Medicine (Family Medicine) Physician	13112	PR

General Provider Information

NPI Number	:	1407855372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE LUIS LOPEZ M.D.

Provider Business Mailing Address
First Line	:	PASEO DEL SOL
Second Line	:	209 CALLE METIS
City	:	DORADO
State	:	PR
Zip	:	00646-4618
Country	:	US
Telephone Number	:	787-405-6346
Fax Number	:	787-278-8494

Provider Business Practice Location Address
First Line	:	SARDINERA BEACH BUILDING, URB. COSTA DE ORO, C/MARGINAL
Second Line	:	SUITE 3
City	:	DORADO
State	:	PR
Zip	:	00646-2055
Country	:	US
Telephone Number	:	787-278-3636
Fax Number	:	787-278-8494

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	02/29/2024

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