Healthcare Provider Details

I. General information

NPI: 1740300060
Provider Name (Legal Business Name): LUZ DIVINA LOPEZ PSICOLOGY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SUITE 728 AVE. E.POL #497
SAN JUAN PR
00926
US

IV. Provider business mailing address

AVE. E. APL 497 SUITE 728
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-617-2657
  • Fax: 787-281-6992
Mailing address:
  • Phone: 787-617-2657
  • Fax: 787-281-6992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number002663
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: