MEDICARE: DR. RAUL EDGARDO LOPEZ 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	2084F0202X	Forensic Psychiatry Physician	9990	PR

General Provider Information

NPI Number	:	1164628319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAUL EDGARDO LOPEZ M.D.

Provider Business Mailing Address
First Line	:	PMB 123
Second Line	:	405 AVE. ESMERALDA
City	:	GUAYNABO
State	:	PR
Zip	:	00969-4457
Country	:	US
Telephone Number	:	787-772-4783
Fax Number	:

Provider Business Practice Location Address
First Line	:	URB HUYKE
Second Line	:	204 CALLE UNION
City	:	SAN JUAN
State	:	PR
Zip	:	00918-0091
Country	:	US
Telephone Number	:	787-772-4783
Fax Number	:	787-789-7484

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

Provider Enumeration Date	:	06/25/2007
Last Update Date	:	09/10/2019

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