Basic Information
| Provider Information | |||||||||
| NPI: | 1285631747 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOPEZ | ||||||||
| FirstName: | FERNANDO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6021 | ||||||||
| Address2: | |||||||||
| City: | CAGUAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007266021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7874136196 | ||||||||
| FaxNumber: | 7872635136 | ||||||||
| Practice Location | |||||||||
| Address1: | HOSPITAL MENONITA- CAYEY | ||||||||
| Address2: | EDIFICIO PROFESIONAL SUITE 303 | ||||||||
| City: | CAYEY | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872635136 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2005 | ||||||||
| LastUpdateDate: | 10/17/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 14167 | PR | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 14167 | PR | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.