Basic Information
| Provider Information | |||||||||
| NPI: | 1407587082 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOPEZ CRUZ | ||||||||
| FirstName: | LUIS | ||||||||
| MiddleName: | MANUEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | HC 2 BOX 7331 | ||||||||
| Address2: | |||||||||
| City: | LAS PIEDRAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007719798 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876101997 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | HOSPITAL ONCOLOGICO DE PUERTO RICO | ||||||||
| Address2: | CENTRO MEDICO DE PUERTO RICO | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877634149 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2022 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 16188-I | PR | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 16188-I | 01 | PR | JUNTA DE LICENCIAMIENTO Y DISCIPLINA MDICA DE PR | OTHER |