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General NPI Number Information
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NPI Number | 1144422858
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Entity Type | Organization
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Legal Business Name | JOSE J LOPEZ AGUDO OFTALMOLOGO CSP
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 04/01/2013
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Provider Practice Location Address
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Address Line | 5Z30 CALLE 5-20 URB. JARDINES MONTEBRISAS
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City | FAJARDO
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State | PR
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Zip | 00738-3911
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Country | US
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Telephone | 787-648-8148
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Fax | 787-863-1230
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Provider Business Mailing Address
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Address Line | PO BOX 909
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City | FAJARDO
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State | PR
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Zip | 00738-0909
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Country | US
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Telephone | 787-648-8148
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Fax | 787-863-1230
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSE LOPEZ
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Credential | MD
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Telephone | 787-632-7441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 11386
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License Number State | PR
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