Healthcare Provider Details

I. General information

NPI: 1689806085
Provider Name (Legal Business Name): MRS. JOAN M. LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOAN M. LOPEZ PSYCHOLOGIST

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 10/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 PONCE DE LEON AVE. UNION PLAZA BLDG. SUITE 1511
SAN JUAN PR
00918-3423
US

IV. Provider business mailing address

PARQUE DE ARCOIRIS NUM.227 2ND. ST. APT.119
TRUJILLO ALTO PR
00976-2853
US

V. Phone/Fax

Practice location:
  • Phone: 787-630-7283
  • Fax:
Mailing address:
  • Phone: 787-627-1773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1960
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: