=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104716562
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VALERIA LOPEZ LOZANO MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2025
-----------------------------------------------------
Last Update Date | 07/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | PR-2 KM 173
-----------------------------------------------------
City | SAN GERMAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00683
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-892-1860
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8602 E 163RD ST S
-----------------------------------------------------
City | BIXBY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74008-5356
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-536-5411
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 17366
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------