Healthcare Provider Details

I. General information

NPI: 1720469190
Provider Name (Legal Business Name): CRISTINA LOPEZ BEAUCHAMP M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SAN JUAN CITY HOSPITAL, MEDICAL CENTER
SAN JUAN PR
00936-8344
US

IV. Provider business mailing address

PO BOX 3944
MAYAGUEZ PR
00681
US

V. Phone/Fax

Practice location:
  • Phone: 787-480-2791
  • Fax:
Mailing address:
  • Phone: 787-645-3409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number21201
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: