MEDICARE: LUMARIE RIVERA 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	16,667	PR

General Provider Information

NPI Number	:	1346342557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUMARIE RIVERA LOPEZ M.D.

Provider Business Mailing Address
First Line	:	1402 CALLE CONVENIENCIA APT 901
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00907-1439
Country	:	US
Telephone Number	:	787-319-9639
Fax Number	:	787-268-4417

Provider Business Practice Location Address
First Line	:	198 CALLLE TRINIDAD
Second Line	:	SUITE 102
City	:	SAN JUAN
State	:	PR
Zip	:	00917-0091
Country	:	US
Telephone Number	:	787-726-5486
Fax Number	:	787-268-4417

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

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	05/24/2019

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