Healthcare Provider Details

I. General information

NPI: 1073338604
Provider Name (Legal Business Name): ALFREDO D LOPEZ CPOA-0094
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4X20 AVE CARLOS JAVIER ANDALUZ STE 4
BAYAMON PR
00956-2984
US

IV. Provider business mailing address

4X20 AVE CARLOS JAVIER ANDALUZ STE 4
BAYAMON PR
00956-2984
US

V. Phone/Fax

Practice location:
  • Phone: 787-998-8939
  • Fax: 787-998-8944
Mailing address:
  • Phone: 787-998-8939
  • Fax: 787-998-8944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberCPOA-0094
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License NumberCPOA-0094
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCPOA-0094
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPOA-0094
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: