MEDICARE: ROBERTO F LOPEZ-ROSARIO MD

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	207V00000X	Obstetrics & Gynecology Physician	13460	PR

General Provider Information

NPI Number	:	1841294642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTO F LOPEZ-ROSARIO MD

Provider Business Mailing Address
First Line	:	PMB 493
Second Line	:	PO BOX 70344
City	:	SAN JUAN
State	:	PR
Zip	:	00936-8344
Country	:	US
Telephone Number	:	787-707-0059
Fax Number	:	787-707-0068

Provider Business Practice Location Address
First Line	:	AVENUE ORTEGON # 107
Second Line	:	CAPARRA GALLERY SUITE 212
City	:	GUAYNABO
State	:	PR
Zip	:	00966
Country	:	US
Telephone Number	:	787-707-0059
Fax Number	:	787-707-0068

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	10/19/2012

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