MEDICARE: KENNICE M LOPEZ-IRIZARRY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	15487	PR

General Provider Information

NPI Number	:	1043260813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNICE M LOPEZ-IRIZARRY M.D.

Provider Business Mailing Address
First Line	:	RR 3 BOX 53099
Second Line	:
City	:	TOA ALTA
State	:	PR
Zip	:	00953-6502
Country	:	US
Telephone Number	:	787-200-5739
Fax Number	:

Provider Business Practice Location Address
First Line	:	2003 AVE BORINQUEN
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00915-3814
Country	:	US
Telephone Number	:	787-268-4171
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	10/07/2016

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