Healthcare Provider Details

I. General information

NPI: 1649196320
Provider Name (Legal Business Name): ALEXANDRA MARIA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 CALLE SANTA CRUZ
BAYAMON PR
00961-7052
US

IV. Provider business mailing address

405 AVE ESMERALDA
GUAYNABO PR
00969-4482
US

V. Phone/Fax

Practice location:
  • Phone: 787-740-4747
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberNA
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: