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General NPI Number Information
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NPI Number | 1295646701
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Entity Type | Organization
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Legal Business Name | LOPEZ & CASTILLO LLC
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Dates
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Enumeration Date | 09/14/2026
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Last Update Date | 09/14/2026
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Provider Practice Location Address
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Address Line | 1900 TEBEAU ST
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City | WAYCROSS
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State | GA
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Zip | 31501-6357
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Country | US
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Telephone | 201-417-9656
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Fax | 770-951-2157
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Provider Business Mailing Address
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Address Line | PO BOX 173
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City | WAYCROSS
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State | GA
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Zip | 31502-0173
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Country | US
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Telephone | 201-417-9656
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Fax | 770-951-2157
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERTO JAFET LOPEZ VEGA
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Credential | MD
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Telephone | 201-417-9656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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