Healthcare Provider Details

I. General information

NPI: 1659208445
Provider Name (Legal Business Name): LUPUS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ESTANCIAS DEL GOLF CLUB 1599 CALLE M RIVERA TEXIDOR
PONCE PR
00730-9898
US

IV. Provider business mailing address

ESTANCIAS DEL GOLF CLUB 1599 CALLE M RIVERA TEXIDOR
PONCE PR
00730-9898
US

V. Phone/Fax

Practice location:
  • Phone: 787-223-2755
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VICTOR CRUZ LOPEZ
Title or Position: OWNER
Credential: MD
Phone: 787-223-2755