Healthcare Provider Details

I. General information

NPI: 1568610368
Provider Name (Legal Business Name): SANDRA IVETTE LOPEZ-HUERTAS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CALLE CASIA
RIO PIEDRAS PR
00921-3200
US

IV. Provider business mailing address

PO BOX 824
BAYAMON PR
00960-0824
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-7582
  • Fax: 787-641-9541
Mailing address:
  • Phone: 787-502-7612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26107
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: