Healthcare Provider Details

I. General information

NPI: 1669458618
Provider Name (Legal Business Name): REYNOLD E LOPEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 PONCE DE LEON AVE SUITE 328
SAN JUAN PR
00917-3418
US

IV. Provider business mailing address

431 PONCE DE LEON AVE SUITE 328
SAN JUAN PR
00917-3418
US

V. Phone/Fax

Practice location:
  • Phone: 787-281-3838
  • Fax: 787-281-0124
Mailing address:
  • Phone: 787-281-3838
  • Fax: 787-281-0124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number4033
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: