=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831165471
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LOURDES JEANETTE FELICIANO LOPEZ MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2006
-----------------------------------------------------
Last Update Date | 05/19/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1427 AVE FERNANDEZ JUNCOS
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00909-2658
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-722-9030
-----------------------------------------------------
Fax | 787-722-9049
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 8520
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00910-0520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-722-9030
-----------------------------------------------------
Fax | 787-722-9049
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | 12891
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------