Healthcare Provider Details

I. General information

NPI: 1417025248
Provider Name (Legal Business Name): HUGO J LOPEZ LIC. AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FENWAY COMM. HEALTH 7 HAVILAND STREET
BOSTON MA
02115
US

IV. Provider business mailing address

39 NEWPORT ST APT. NO. 3
DORCHESTER MA
02125-1224
US

V. Phone/Fax

Practice location:
  • Phone: 617-927-6296
  • Fax:
Mailing address:
  • Phone: 617-927-6296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number564
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: