Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 266247 | NY |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 266247 | NY |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 266247 | NY |
NPI | 1548609126 |
---|---|
Provider Name | Santiago Lopez |
First Address | New York, NY 10003-3821 |
Second Address | New York, NY 10003-3821 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2013 |
Last Update Date | 17/06/2013 |