Individual
SANTIAGO LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
353 E 17TH ST FL 2, NEW YORK, NY 10003-3821
(212) 420-3743
Mailing address
353 E 17TH ST FL 2, NEW YORK, NY 10003-3821
(212) 420-3743
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
266247
NY
207QG0300X
Geriatric Medicine (Family Medicine) Physician
266247
NY
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
Primary
266247
NY
Other
Enumeration date
06/17/2013
Last updated
06/17/2013
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