Healthcare Provider Details

I. General information

NPI: 1245084383
Provider Name (Legal Business Name): RYAN LOPEZ CONCEPCION MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 12/06/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 4055
AGUADILLA PR
00605-4055
US

IV. Provider business mailing address

HC 3 BOX 33708
AGUADA PR
00602-9743
US

V. Phone/Fax

Practice location:
  • Phone: 787-658-0200
  • Fax:
Mailing address:
  • Phone: 939-349-9867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number024716
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: