Healthcare Provider Details

I. General information

NPI: 1295343267
Provider Name (Legal Business Name): DAVID AGUSTIN LOPEZ RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MAYAGUEZ MEDICAL CENTER AVENIDA HOSTOS #410
MAYAGUEZ PR
00682-1560
US

IV. Provider business mailing address

MAYAGUEZ MEDICAL CENTER PO BOX 600
MAYAGUEZ PR
00681
US

V. Phone/Fax

Practice location:
  • Phone: 787-652-9200
  • Fax:
Mailing address:
  • Phone: 787-752-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number23321
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number23321
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number23321
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: