NPI Code Detail JSON Logo

1487041596 NPI number — KEYSHA MARIE LOPEZ VEGA MD

NPI Number: 1487041596
Health Care Provider/Practitioner: KEYSHA MARIE LOPEZ VEGA MD

Information about “1487041596” NPI (KEYSHA MARIE LOPEZ VEGA MD) exists in 1487041596 in HTML format HTML  |  1487041596 in plain Text format TXT  |  1487041596 in PDF (Portable Document Format) PDF  |  1487041596 in an XML format XML  formats.

NPI Number : 1487041596 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1487041596",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LOPEZ VEGA",
    "FirstName": "KEYSHA",
    "MiddleName": "MARIE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1033 CALLE CERRO SALIENTE",
    "SecondLineMailingAddress": "URB. QUINTAS DE ALTAMIRA",
    "MailingAddressCityName": "JUANA DIAZ",
    "MailingAddressStateName": "PR",
    "MailingAddressPostalCode": "00795-9107",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "787-316-3753",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "155 AVE ARTERIAL HOSTOS APT 222",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAN JUAN",
    "PracticeLocationAddressStateName": "PR",
    "PracticeLocationAddressPostalCode": "00918-2938",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "787-316-3753",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/16/2015",
    "LastUpdateDate": "07/06/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207R00000X",
          "TaxonomyName": "Internal Medicine Physician",
          "LicenseNumber": "21131",
          "LicenseNumberStateCode": "PR",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "390200000X",
          "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
          "LicenseNumber": "TL.0008177",
          "LicenseNumberStateCode": "CO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207RN0300X",
          "TaxonomyName": "Nephrology Physician",
          "LicenseNumber": "21131",
          "LicenseNumberStateCode": "PR",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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