Healthcare Provider Details

I. General information

NPI: 1265492201
Provider Name (Legal Business Name): AGUSTIN J LOPEZ-COVAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 03/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 CALLE FONT MARTELO
HUMACAO PR
00791-3229
US

IV. Provider business mailing address

PO BOX 428
HUMACAO PR
00792-0428
US

V. Phone/Fax

Practice location:
  • Phone: 787-852-0886
  • Fax: 787-852-0280
Mailing address:
  • Phone: 787-852-0886
  • Fax: 787-852-0280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number10627
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: