Healthcare Provider Details

I. General information

NPI: 1548749757
Provider Name (Legal Business Name): JOSE ENRIQUE LOPEZ RIVERA BSN/RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CONSOLIDATED MALL B5 202 AVE GAUTIER BENITEZ
CAGUAS PR
00726-0000
US

IV. Provider business mailing address

PO BOX 370814
CAYEY PR
00737-0814
US

V. Phone/Fax

Practice location:
  • Phone: 787-704-0705
  • Fax:
Mailing address:
  • Phone: 787-557-0478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number86976
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: