Healthcare Provider Details

I. General information

NPI: 1013468974
Provider Name (Legal Business Name): CARLOS A LOPEZ CPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COND AMERICAS
SAN JUAN PR
00909-2152
US

IV. Provider business mailing address

A3 CALLE MONFORTE
SAN JUAN PR
00926-2501
US

V. Phone/Fax

Practice location:
  • Phone: 787-474-0300
  • Fax:
Mailing address:
  • Phone: 787-696-4849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281PC2000X
TaxonomyChildren's Chronic Disease Hospital
License Number8537
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number8537
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: