Healthcare Provider Details

I. General information

NPI: 1962945311
Provider Name (Legal Business Name): WANDA L LOPEZ-ALMA M.T.,M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2016
Last Update Date: 12/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CALLE 65 INFNTRIA S SUITE 2
LAJAS PR
00667-2013
US

IV. Provider business mailing address

20 CALLE 65 INFANTERIA SUR SUITE 2
LAJAS PUERTO RICO
00667
UM

V. Phone/Fax

Practice location:
  • Phone: 787-899-3670
  • Fax: 787-899-2163
Mailing address:
  • Phone: 787-899-3670
  • Fax: 787-899-2163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QL0900X
TaxonomyLaboratory Management Specialist/Technologist
License Number3672
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: