MEDICARE: MR. ANGEL LUIS LOPEZ RUIZ 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
1	174400000X	Specialist	6996	PR
2	208600000X	Surgery Physician	006996	PR

General Provider Information

NPI Number	:	1881682730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANGEL LUIS LOPEZ RUIZ M.D.

Provider Business Mailing Address
First Line	:	29 WASHINGTON ST
Second Line	:	SUITE 205
City	:	SAN JUAN
State	:	PR
Zip	:	00907-1509
Country	:	US
Telephone Number	:	787-722-6795
Fax Number	:	787-723-1205

Provider Business Practice Location Address
First Line	:	29 WASHINGTON ST
Second Line	:	SUITE 205
City	:	SAN JUAN
State	:	PR
Zip	:	00907-1509
Country	:	US
Telephone Number	:	787-722-6795
Fax Number	:	787-723-1205

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

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	04/11/2018

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