Healthcare Provider Details

I. General information

NPI: 1831128420
Provider Name (Legal Business Name): MICHELLE LOPEZ LOPEZ M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37-19 CALLE 36
CAROLINA PR
00985-5502
US

IV. Provider business mailing address

67ST 119#29 VILLA CAROLINA
CAROLINA PR
00985-5322
US

V. Phone/Fax

Practice location:
  • Phone: 787-768-4993
  • Fax: 787-768-0040
Mailing address:
  • Phone: 787-701-0850
  • Fax: 787-768-0040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number15624
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: