MEDICARE: DR. FERNANDO JUAN LOPEZ-MALPICA 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	207K00000X	Allergy & Immunology Physician	4804	PR

General Provider Information

NPI Number	:	1699805572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FERNANDO JUAN LOPEZ-MALPICA MD

Provider Business Mailing Address
First Line	:	RIO PIEDRAS HEIGHTS
Second Line	:	1728 CALLE SEGRE
City	:	RIO PIEDRAS
State	:	PR
Zip	:	00926-3257
Country	:	US
Telephone Number	:	787-758-1621
Fax Number	:

Provider Business Practice Location Address
First Line	:	LOMAS VERDES CALLE S
Second Line	:	URB RIO PIEDRAS HEIGHTS
City	:	RIO PIEDRAS
State	:	PR
Zip	:	00926-0001
Country	:	US
Telephone Number	:	787-758-1621
Fax Number	:

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

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	12/17/2007

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