MEDICARE: MRS. MARIA M. LOPEZ PED.

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	208000000X	Pediatrics Physician	10931	PR

General Provider Information

NPI Number	:	1609872050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIA M. LOPEZ PED.

Provider Business Mailing Address
First Line	:	PO BOX 9572
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00726-9572
Country	:	US
Telephone Number	:	787-714-4983
Fax Number	:	787-714-4983

Provider Business Practice Location Address
First Line	:	12 CALLE BARCELO
Second Line	:
City	:	CIDRA
State	:	PR
Zip	:	00739-3446
Country	:	US
Telephone Number	:	787-714-4983
Fax Number	:	787-714-4983

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	07/08/2007

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