Provider Demographics
NPI:1144062670
Name:LOPEZ DIAZ, JOSE ALEJANDRO (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ALEJANDRO
Last Name:LOPEZ DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CELLE 12 Y CALLE RIO DE JANEIRO 0E3-313
Mailing Address - Street 2:SAN JOSE DE MARIA CALDERON
Mailing Address - City:QUITO
Mailing Address - State:PIDINCHA
Mailing Address - Zip Code:170204
Mailing Address - Country:EC
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:234 E 149TH ST
Practice Address - Street 2:BRONX, NY 10451
Practice Address - City:THE BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451
Practice Address - Country:US
Practice Address - Phone:593-984-6251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-06
Last Update Date:2025-01-27
Deactivation Date:2025-01-16
Deactivation Code:
Reactivation Date:2025-01-27
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program