Basic Information
| Provider Information | |||||||||
| NPI: | 1750839148 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANABRIA LOPEZ | ||||||||
| FirstName: | JOHNNY | ||||||||
| MiddleName: | ALEXANDER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 365067 | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009365067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877540101 | ||||||||
| FaxNumber: | 7877513911 | ||||||||
| Practice Location | |||||||||
| Address1: | AA33 CALLE LAUREL NORTE | ||||||||
| Address2: | URB QUINTAS DE DORADO | ||||||||
| City: | DORADO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7879003696 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2016 | ||||||||
| LastUpdateDate: | 03/02/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 19413 | PR | N | Allopathic & Osteopathic Physicians | General Practice | 2084N0400X | 19413 | PR | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.