Healthcare Provider Details

I. General information

NPI: 1508079153
Provider Name (Legal Business Name): AUDAY LOPEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. ESTATAL # 2 BO. JUAN SANCHEZ
BAYAMON PR
00960
US

IV. Provider business mailing address

LINCOLN 151 JARDINES DE CASABLANCA
TOA ALTA PR
00953
US

V. Phone/Fax

Practice location:
  • Phone: 787-782-8250
  • Fax:
Mailing address:
  • Phone: 787-251-2528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number9572
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: