Healthcare Provider Details

I. General information

NPI: 1144058033
Provider Name (Legal Business Name): ABDIEL SEBASTIAN LOPEZ MORALES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR #1 VILLAS BLANCA INDUSTRIAL PARK SUITE 120
CAGUAS PR
00727
US

IV. Provider business mailing address

URBANIZACION RIO PIEDRAS HEIGHTS 1684 CALLE SUNGARI
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-920-4090
  • Fax:
Mailing address:
  • Phone: 787-201-1638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: