Healthcare Provider Details

I. General information

NPI: 1699805572
Provider Name (Legal Business Name): FERNANDO JUAN LOPEZ-MALPICA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LOMAS VERDES CALLE S URB RIO PIEDRAS HEIGHTS
RIO PIEDRAS PR
00926-0001
US

IV. Provider business mailing address

RIO PIEDRAS HEIGHTS 1728 CALLE SEGRE
RIO PIEDRAS PR
00926-3257
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-1621
  • Fax:
Mailing address:
  • Phone: 787-758-1621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number4804
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: