Provider Demographics
NPI:1881806248
Name:CDT DR LOPEZ ANTONGIORGI
Entity type:Organization
Organization Name:CDT DR LOPEZ ANTONGIORGI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LIC
Authorized Official - Phone:787-480-5240
Mailing Address - Street 1:PO BOX 21405
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928-1405
Mailing Address - Country:US
Mailing Address - Phone:787-480-5240
Mailing Address - Fax:
Practice Address - Street 1:333 CALLE 25 NE
Practice Address - Street 2:
Practice Address - City:PUERTO NUEVO
Practice Address - State:PR
Practice Address - Zip Code:00920-2531
Practice Address - Country:US
Practice Address - Phone:787-793-8989
Practice Address - Fax:787-792-7355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-05
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR10219CDOtherTRIPLE S TODOS
PR9170111OtherHUMANA TODAS
PR1001027OtherACCA
PR1140OtherPROSAM
PR6604279JLOtherCOSVI REFORMA Y PRIVADO
PR7811OtherFIRST MEDICAL
PR030362OtherCRUZ AZUL
PR600304OtherUTI
PR600304OtherUTI
PR7811OtherFIRST MEDICAL
PR=========OtherCIGNA REFORMA Y PREFERRED
PR=========OtherMCS LIFE
PR=========OtherPAN AMERICAN
PR=========OtherGOLDEN CROSS
PR1001027OtherACCA
PR=========OtherMAPHRE
PR=========4MedicaidMCS REFORMA
PR=========4Medicaid
PR=========OtherMCS LIFE
PR=========OtherMCS CLASSICARE
PR=========OtherAMERICAN HEALTH