Healthcare Provider Details

I. General information

NPI: 1033319017
Provider Name (Legal Business Name): MR. JIMMY LOPEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ANTIGUO HOSPITAL DE DISTRITO CARR 129 , 2DO PISO
ARECIBO PR
00612
US

IV. Provider business mailing address

HC 5 BOX 29858
CAMUY PR
00627-9875
US

V. Phone/Fax

Practice location:
  • Phone: 787-878-3552
  • Fax: 787-879-8633
Mailing address:
  • Phone: 787-820-6463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number22340
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: