Healthcare Provider Details

I. General information

NPI: 1346342557
Provider Name (Legal Business Name): LUMARIE RIVERA LOPEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 05/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 CALLLE TRINIDAD SUITE 102
SAN JUAN PR
00917-0091
US

IV. Provider business mailing address

1402 CALLE CONVENIENCIA APT 901
SAN JUAN PR
00907-1439
US

V. Phone/Fax

Practice location:
  • Phone: 787-726-5486
  • Fax: 787-268-4417
Mailing address:
  • Phone: 787-319-9639
  • Fax: 787-268-4417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number16,667
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: