=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295610319
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIAN ANDRE LOPEZ-MENDIZABAL DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2025
-----------------------------------------------------
Last Update Date | 10/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2045 AV DR PEDRO ALBIZU CAMPOS 5
-----------------------------------------------------
City | AGUADILLA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-669-1458
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | ALTURAS DE MAYAGUEZ 1900 CALLE LALIZA
-----------------------------------------------------
City | MAYAGUEZ
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00682
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-579-5141
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NS0005X
-----------------------------------------------------
Taxonomy Name | Sports Physician Chiropractor
-----------------------------------------------------
License Number | 939
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------