Healthcare Provider Details

I. General information

NPI: 1831165471
Provider Name (Legal Business Name): LOURDES JEANETTE FELICIANO LOPEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 05/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1427 AVE FERNANDEZ JUNCOS
SAN JUAN PR
00909-2658
US

IV. Provider business mailing address

PO BOX 8520
SAN JUAN PR
00910-0520
US

V. Phone/Fax

Practice location:
  • Phone: 707-722-9030
  • Fax: 787-722-9049
Mailing address:
  • Phone: 787-722-9030
  • Fax: 787-722-9049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number12891
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: