Provider Demographics
NPI:1528130952
Name:LOPEZ LOPEZ, RICARDO (MD)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:LOPEZ LOPEZ
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:PO BOX 141408
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-1408
Mailing Address - Country:US
Mailing Address - Phone:787-449-8488
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 492 KM 2.9
Practice Address - Street 2:BARRIO CARCOVADA
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-820-0542
Practice Address - Fax:787-820-0542
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14057208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
0021078Medicare ID - Type Unspecified
I18758Medicare UPIN