Provider Demographics
NPI:1831165471
Name:FELICIANO LOPEZ, LOURDES JEANETTE (MD)
Entity type:Individual
Prefix:MRS
First Name:LOURDES
Middle Name:JEANETTE
Last Name:FELICIANO LOPEZ
Suffix:
Gender:F
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 8520
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-0520
Mailing Address - Country:US
Mailing Address - Phone:787-722-9030
Mailing Address - Fax:787-722-9049
Practice Address - Street 1:1427 AVE FERNANDEZ JUNCOS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2658
Practice Address - Country:US
Practice Address - Phone:707-722-9030
Practice Address - Fax:787-722-9049
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2017-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12891207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0020987Medicare ID - Type Unspecified
H69384Medicare UPIN