Healthcare Provider Details

I. General information

NPI: 1841294642
Provider Name (Legal Business Name): ROBERTO F LOPEZ-ROSARIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 10/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVENUE ORTEGON # 107 CAPARRA GALLERY SUITE 212
GUAYNABO PR
00966
US

IV. Provider business mailing address

PMB 493 PO BOX 70344
SAN JUAN PR
00936-8344
US

V. Phone/Fax

Practice location:
  • Phone: 787-707-0059
  • Fax: 787-707-0068
Mailing address:
  • Phone: 787-707-0059
  • Fax: 787-707-0068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number13460
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: