Individual
DR. MARIEMMA MAGE LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
COMPLEJO CORRECCIONAL LAS CUCHARAS, EL TUQUE, PONCE, PR 00732
(787) 841-8005
Mailing address
PO BOX 800250, COTO LAUREL, PR 00780-0250
(787) 848-1826
(787) 843-8977
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
15039
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15039
STATE LICENSE
PR
Enumeration date
05/25/2007
Last updated
07/08/2007
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