MEDICARE: DR. MIGUEL A LOPEZ-DIAZ MD

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	207RC0000X	Cardiovascular Disease Physician	5779	PR

General Provider Information

NPI Number	:	1568433852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIGUEL A LOPEZ-DIAZ MD

Provider Business Mailing Address
First Line	:	243 CALLE PARIS
Second Line	:	PMB 1689
City	:	SAN JUAN
State	:	PR
Zip	:	00917-3632
Country	:	US
Telephone Number	:	787-728-5967
Fax Number	:	787-728-5967

Provider Business Practice Location Address
First Line	:	1801 AVE PONCE DE LEON
Second Line	:	SANTURCE MEDICAL MALL, OFICE 406
City	:	SAN JUAN
State	:	PR
Zip	:	00909-1900
Country	:	US
Telephone Number	:	787-728-5967
Fax Number	:

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

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	02/28/2013

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