Provider Demographics
NPI:1447360755
Name:LOPEZ-ROSARIO, LOIDA (MD)
Entity type:Individual
Prefix:DR
First Name:LOIDA
Middle Name:
Last Name:LOPEZ-ROSARIO
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 143112
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-3112
Mailing Address - Country:US
Mailing Address - Phone:787-898-2337
Mailing Address - Fax:787-898-2337
Practice Address - Street 1:CARR.130 KM.11.6 BO. CAMPO ALEGRE
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-898-2337
Practice Address - Fax:787-898-2337
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11167208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG-02891Medicare UPIN