Healthcare Provider Details

I. General information

NPI: 1053167361
Provider Name (Legal Business Name): MIGUEL ANGEL BEAUCHAMP LOPEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2024
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE HOSTOS 410 CARR. #2, BO SABALOS
MAYAGUEZ PR
00680-1526
US

IV. Provider business mailing address

HC 3 BOX 33680
AGUADA PR
00602-9740
US

V. Phone/Fax

Practice location:
  • Phone: 787-652-9200
  • Fax:
Mailing address:
  • Phone: 480-793-2249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number17479-I
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25143
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2164
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: