Healthcare Provider Details

I. General information

NPI: 1871158667
Provider Name (Legal Business Name): HECTOR MANUEL LOPEZ GONZALEZ MD, MHA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 05/24/2025
Certification Date: 05/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 PASEO DEL VETERANO
PONCE PR
00716-2001
US

IV. Provider business mailing address

PO BOX 151
PONCE PR
00715-0151
US

V. Phone/Fax

Practice location:
  • Phone: 787-492-0111
  • Fax: 787-812-1034
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number23275
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA12190300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: