Healthcare Provider Details

I. General information

NPI: 1134014285
Provider Name (Legal Business Name): MARILIS LOPERENA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 5 BOX 53978
SAN SEBASTIAN PR
00685-5766
US

IV. Provider business mailing address

HC 5 BOX 53978
SAN SEBASTIAN PR
00685-5766
US

V. Phone/Fax

Practice location:
  • Phone: 787-932-5275
  • Fax:
Mailing address:
  • Phone: 787-932-5275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number7812
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number7812
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: