Healthcare Provider Details

I. General information

NPI: 1275454100
Provider Name (Legal Business Name): EDIG GABRIEL LOPEZ TORRES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. QUISQUEYA 61, ESQUINA CHILE HATO REY
SAN JUAN PR
00917
US

IV. Provider business mailing address

PARCELAS NIAGARAS CALLE RUBI #42 B
COAMO PR
00769
US

V. Phone/Fax

Practice location:
  • Phone: 939-732-1529
  • Fax:
Mailing address:
  • Phone: 939-732-1529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: