Healthcare Provider Details

I. General information

NPI: 1023093176
Provider Name (Legal Business Name): MRS. GUADALUPE G LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE 65 INFANTERIA K-M 3.4 BARRIO SABANA LLANA
SAN JUAN PR
00924
US

IV. Provider business mailing address

CALLE 46 SE 1187 REPARTO METROPOLITONO RIO DIERES
SAN JUAN PR
00921
US

V. Phone/Fax

Practice location:
  • Phone: 787-769-7676
  • Fax: 787-281-0194
Mailing address:
  • Phone: 787-767-7676
  • Fax: 787-281-0194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number025987
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: