MEDICARE: RICARDO 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	2085R0204X	Vascular & Interventional Radiology Physician	23567	PR
2	2085R0202X	Diagnostic Radiology Physician	64241	MN
3	2085R0202X	Diagnostic Radiology Physician	23567	PR

General Provider Information

NPI Number	:	1780117101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICARDO A LOPEZ DIAZ MD

Provider Business Mailing Address
First Line	:	200 1ST ST SW
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55905-0001
Country	:	US
Telephone Number	:	507-284-2511
Fax Number	:

Provider Business Practice Location Address
First Line	:	PR-2, KM 11.7
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00959
Country	:	US
Telephone Number	:	787-620-8181
Fax Number	:

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

Provider Enumeration Date	:	04/04/2017
Last Update Date	:	05/07/2026

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