| Doctor Name: | DERIC ALEJANDRO LOPEZ |
| NPI Number: | 1043644412 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 15337 |
| Business Practice Address: | Carretera 2 Interseccion 668 Urbanization Athenas Manati, PR - 00674 |
| Business Phone Number: | 7876213700 |
| Business Fax Number: | |
| Mailing Address: | Carr 2 Interseccion 668, Urbanization Athenas MANATI |
| State: | PR |
| Postal Code: | 00674 |
| Phone Number: | 7876213700 |
| Fax Number: | |
| NPI Enumeration Date: | 08/21/2013 |
| NPI Last Update Date: | 01/07/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 15337 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | PR |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |