Healthcare Provider Details

I. General information

NPI: 1164333605
Provider Name (Legal Business Name): JOSE ENRIQUE LOPEZ SEKULITS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

B18 CALLE MARGINAL
MANATI PR
00674-5435
US

IV. Provider business mailing address

JI30 CALLE J
ARECIBO PR
00612-2831
US

V. Phone/Fax

Practice location:
  • Phone: 787-884-9062
  • Fax:
Mailing address:
  • Phone: 787-647-3161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number002546
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: