Provider Demographics
NPI:1437663978
Name:ROLON LOPEZ, JONATHAN E
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:E
Last Name:ROLON LOPEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 3 BOX 7577
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-9762
Mailing Address - Country:US
Mailing Address - Phone:787-553-5654
Mailing Address - Fax:
Practice Address - Street 1:CENTRO COMERCIAL
Practice Address - Street 2:EDIF 10A LOCAL 3 Y 4 AVE. FONT MARTELO
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-704-0705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR84504163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR84504OtherENFERMERO