Healthcare Provider Details

I. General information

NPI: 1881806248
Provider Name (Legal Business Name): CDT DR LOPEZ ANTONGIORGI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2007
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CALLE 25 NE
PUERTO NUEVO PR
00920-2531
US

IV. Provider business mailing address

PO BOX 21405
SAN JUAN PR
00928-1405
US

V. Phone/Fax

Practice location:
  • Phone: 787-793-8989
  • Fax: 787-792-7355
Mailing address:
  • Phone: 787-480-5240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGELIZ RODRIGUEZ
Title or Position: ADMINISTRATOR
Credential: LIC
Phone: 787-480-5240