Healthcare Provider Details

I. General information

NPI: 1316874159
Provider Name (Legal Business Name): ARIAM JELLENE LOPEZ CRESPO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 CALLE SANTA CRUZ
BAYAMON PR
00961-7031
US

IV. Provider business mailing address

URB QTAS DE FLAMINGO D2 CALLE 3
BAYAMON PR
00959-4854
US

V. Phone/Fax

Practice location:
  • Phone: 787-620-4747
  • Fax:
Mailing address:
  • Phone: 787-587-4097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: