Healthcare Provider Details

I. General information

NPI: 1700402385
Provider Name (Legal Business Name): PAULA ANGELICA NEGRON LOPEZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2020
Last Update Date: 04/05/2026
Certification Date: 04/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 466
TRUJILLO ALTO PR
00977
US

IV. Provider business mailing address

PO BOX 466
TRUJILLO ALTO PR
00977
US

V. Phone/Fax

Practice location:
  • Phone: 787-634-9663
  • Fax:
Mailing address:
  • Phone: 787-634-9663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number8620
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number8620
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number8620
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: