Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 16866 | PR |
N | 208D00000X | General Practice Physician | 16866 | PR |
NPI | 1093909996 |
---|---|
Provider Name | Dr. Shirley Perez-Lopez |
First Address | Gurabo, PR 00778-9687 |
Second Address | Caguas, PR 00725 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2007 |
Last Update Date | 19/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002-8163 | PTAN (01) | PR |