Healthcare Provider Details

I. General information

NPI: 1104818509
Provider Name (Legal Business Name): ELBA LOPEZ RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7353 AVE RAMOS CALERO A
ISABELA PR
00662-3500
US

IV. Provider business mailing address

302 CALLE DR HERNANDEZ DEL VALLE
ISABELA PR
00662-3919
US

V. Phone/Fax

Practice location:
  • Phone: 787-872-0415
  • Fax: 787-872-0415
Mailing address:
  • Phone: 787-872-0415
  • Fax: 787-872-0415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number739
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: