Healthcare Provider Details

I. General information

NPI: 1942570882
Provider Name (Legal Business Name): RUTH JOHANNA LOPEZ LIC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 05/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. SABANERA DORADO # 484 CAMINO EL YUNQUE
DORADO PR
00646
US

IV. Provider business mailing address

URB. SABANERA DORADO # 484 CAMINO EL YUNQUE
DORADO PR
00646-3640
US

V. Phone/Fax

Practice location:
  • Phone: 787-960-4748
  • Fax: 787-796-8529
Mailing address:
  • Phone: 787-960-4748
  • Fax: 787-946-4414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number4134
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: