MEDICARE: DR. CARMEN 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	208D00000X	General Practice Physician	9791	PR

General Provider Information

NPI Number	:	1255314746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARMEN LOPEZ M.D

Provider Business Mailing Address
First Line	:	L1 CALLE 4 VILLAS DE RIO GRANDE
Second Line	:
City	:	RIO GRANDE
State	:	PR
Zip	:	00745-0000
Country	:	US
Telephone Number	:	787-888-7336
Fax Number	:	787-887-4045

Provider Business Practice Location Address
First Line	:	L1 CALLE 4
Second Line	:	VILLAS DE RIO GRANDE
City	:	RIO GRANDE
State	:	PR
Zip	:	00745-0000
Country	:	US
Telephone Number	:	787-888-7336
Fax Number	:	787-887-4045

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

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	08/09/2022

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