Healthcare Provider Details

I. General information

NPI: 1073931903
Provider Name (Legal Business Name): JOVANNA BERTRAN-LOPEZ MD MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. PONCE DE LEON, PARADA 37.5
SAN JUAN PR
00919-1227
US

IV. Provider business mailing address

1353 AVE. LUIS VIGOREAUX, PMB 332
GUAYNABO PR
00966
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2000
  • Fax:
Mailing address:
  • Phone: 787-225-0411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME141547
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number19323
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: