Healthcare Provider Details

I. General information

NPI: 1881412831
Provider Name (Legal Business Name): LUIS GEOVANNY GALBAN LOPEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 09/30/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO HATO ABAJO KM 81.0 CARR #2
ARECIBO PR
00612
US

IV. Provider business mailing address

URB VISTA AZUL T21 CALLE #25
ARECIBO PR
00612
US

V. Phone/Fax

Practice location:
  • Phone: 787-896-1850
  • Fax:
Mailing address:
  • Phone: 787-236-1070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2249
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: