Provider Demographics
NPI:1871877068
Name:LOPEZ GARCIA, NYDIA JUDITH (MD)
Entity type:Individual
Prefix:DR
First Name:NYDIA JUDITH
Middle Name:
Last Name:LOPEZ GARCIA
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 1:917 AVE TITO CASTRO
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-4717
Mailing Address - Country:US
Mailing Address - Phone:787-844-2080
Mailing Address - Fax:787-844-1372
Practice Address - Street 1:917 AVE TITO CASTRO
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4717
Practice Address - Country:US
Practice Address - Phone:787-844-2080
Practice Address - Fax:787-844-1372
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR28577R208000000X
PR20641281PC2000X, 282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No281PC2000XHospitalsChronic Disease HospitalChildren
No282NC2000XHospitalsGeneral Acute Care HospitalChildren