Healthcare Provider Details

I. General information

NPI: 1194538413
Provider Name (Legal Business Name): RAFAEL EDUARDO LOPEZ DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 115 KM 8.7 LOCAL 4
RINCON PR
00677
US

IV. Provider business mailing address

PO BOX 1567
MAYAGUEZ PR
00681-1567
US

V. Phone/Fax

Practice location:
  • Phone: 787-456-6444
  • Fax:
Mailing address:
  • Phone: 787-487-7474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1014
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: