Healthcare Provider Details

I. General information

NPI: 1184616336
Provider Name (Legal Business Name): ZELMA Z FUXENCH LOPEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#66 SANTA CRUZ ST. INSTITUTO SAN PABLO - SUITE 409
BAYAMON PR
00960
US

IV. Provider business mailing address

URB. BUCARE #29 AMATISTA ST.
GUAYNABO PR
00969
US

V. Phone/Fax

Practice location:
  • Phone: 787-787-5045
  • Fax: 787-798-1690
Mailing address:
  • Phone: 787-720-8113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number6566
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: