Healthcare Provider Details

I. General information

NPI: 1922082445
Provider Name (Legal Business Name): LIONEL FERNANDEZ-LOPEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CALLE CRISALIDA URB. MUNOZ RIVERA
GUAYNABO PR
00969-3609
US

IV. Provider business mailing address

URB. LA COLINA STREET B #29
GUAYNABO PR
00969-3261
US

V. Phone/Fax

Practice location:
  • Phone: 787-720-5238
  • Fax: 787-272-0824
Mailing address:
  • Phone: 787-720-5222
  • Fax: 787-789-7604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number7851
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: