Healthcare Provider Details

I. General information

NPI: 1790074904
Provider Name (Legal Business Name): MR. ERWIN EDUARDO RAYO LOPEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ERWIN EDUARDO RAYO LOPEZ M.D.

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF PUERTO RICO UPR-MEDICAL SCIENCES CAMPUS
SAN JUAN PR
00936-3185
US

IV. Provider business mailing address

1177 CALLE 56 SE REPARTO METROPOLITANO
SAN JUAN PR
00921-2728
US

V. Phone/Fax

Practice location:
  • Phone: 787-754-0101
  • Fax:
Mailing address:
  • Phone: 787-363-9515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number179-E
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: