Healthcare Provider Details

I. General information

NPI: 1952355968
Provider Name (Legal Business Name): MARIO R. LOPEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MARIO R. LOPEZ-CABRERA MD

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 05/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116-1 CALLE 74 VILLA CAROLINA
CAROLINA PR
00985-4117
US

IV. Provider business mailing address

116-1 CALLE 74 VILLA CAROLINA
CAROLINA PR
00985-4117
US

V. Phone/Fax

Practice location:
  • Phone: 787-402-9031
  • Fax: 866-396-9013
Mailing address:
  • Phone: 787-402-9031
  • Fax: 866-396-9013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME 75291
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number18378
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: