Healthcare Provider Details

I. General information

NPI: 1871424424
Provider Name (Legal Business Name): LISAMARY LOPEZ ORTEGA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 6021
CAROLINA PR
00984-6021
US

IV. Provider business mailing address

1101 CALLE 7
SAN JUAN PR
00927-5331
US

V. Phone/Fax

Practice location:
  • Phone: 787-757-1800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: