Active NPI
Mariemma Mage Lopez, MD
- General Practice Physician
- Ponce, PR
National Provider Identifier
1740491174
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 15039
- Practice address
- Complejo Correccional Las Cucharas
El Tuque
Ponce, PR 00732 - Phone
- (787) 841-8005
- NPI assigned
- May 25, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 15039 | PR | Primary |
Addresses
Primary practice location
Complejo Correccional Las Cucharas
El Tuque
Ponce, PR 00732
Mailing address
PO Box 800250
Coto Laurel, PR 00780-0250
Phone (787) 848-1826
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 15039 | Other | PR | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15039 | PR | MD | General Practice Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Centro Ceski C S P | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Multi-Specialty Clinic/Center
- Penuelas, PR
- NPI 1194959122
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180051200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1740491174",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 800250",
"city": "COTO LAUREL",
"state": "PR",
"postal_code": "007800250",
"telephone_number": "787-848-1826",
"fax_number": "787-843-8977"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "COMPLEJO CORRECCIONAL LAS CUCHARAS",
"address_2": "EL TUQUE",
"city": "PONCE",
"state": "PR",
"postal_code": "00732",
"telephone_number": "787-841-8005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOPEZ",
"first_name": "MARIEMMA",
"middle_name": "MAGE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "PR",
"license": "15039",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "15039",
"state": "PR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ponce, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.