Provider Demographics
NPI:1205416013
Name:LOPEZ, JOSE MIGUEL (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:MIGUEL
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:MIGUEL
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:HC 03 BOX 41425
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-320-0040
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 183 KM 5.0 TOMAS DE CASTRO 2
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-320-0040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000742-P.A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant