Healthcare Provider Details

I. General information

NPI: 1740953314
Provider Name (Legal Business Name): NESILU LOPEZ MT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 07/29/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 MIRAMAR II, H1
ARROYO PR
00714
US

IV. Provider business mailing address

PO BOX 403
ARROYO PR
00714-0403
US

V. Phone/Fax

Practice location:
  • Phone: 787-690-4889
  • Fax:
Mailing address:
  • Phone: 787-690-4889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number2645
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: