Healthcare Provider Details

I. General information

NPI: 1255780649
Provider Name (Legal Business Name): KARILYN LOPEZ NEGRON RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 CALLE 54 SE
SAN JUAN PR
00921-3143
US

IV. Provider business mailing address

320 VALLE DE TORRIMAR
GUAYNABO PR
00966-8706
US

V. Phone/Fax

Practice location:
  • Phone: 787-999-5538
  • Fax:
Mailing address:
  • Phone: 787-632-9257
  • Fax: 787-999-5539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number1556
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: