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NPI Code Detail

MEDICARE: DR. JAIME PEDRO LOPEZ-REVEROL M.D.

MEDICARE: DR. JAIME PEDRO LOPEZ-REVEROL 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
1174400000XSpecialist6830PR

General Provider Information

NPI Number : 1386645182
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAIME PEDRO LOPEZ-REVEROL M.D.
Provider Business Mailing Address
First Line : INST SAN PABLO
Second Line : SUITE 306
City : BAYAMON
State : PR
Zip : 00961-7041
Country : US
Telephone Number : 787-786-2690
Fax Number : 787-787-5413
Provider Business Practice Location Address
First Line : INST SAN PABLO SANTA CRUZ ST.#66
Second Line : SUITE 306
City : BAYAMON
State : PR
Zip : 00961-7041
Country : US
Telephone Number : 787-786-2690
Fax Number : 787-787-5413
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2005
Last Update Date : 12/15/2008

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