Healthcare Provider Details

I. General information

NPI: 1497706170
Provider Name (Legal Business Name): OSVALDO LOPERENA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 11/25/2021
Certification Date: 11/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. # 2 KM 142.2 BO. QUEBRADA LARGA
ANASCO PR
00610
US

IV. Provider business mailing address

PO BOX 2093
ANASCO PR
00610-3001
US

V. Phone/Fax

Practice location:
  • Phone: 787-826-4444
  • Fax:
Mailing address:
  • Phone: 787-235-3167
  • Fax: 787-826-4444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1002
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: