Healthcare Provider Details

I. General information

NPI: 1922730407
Provider Name (Legal Business Name): YARIS L LOPEZ MONTALVO MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: YARIS L LOPEZ MSW

II. Dates (important events)

Enumeration Date: 06/24/2022
Last Update Date: 06/24/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. JESUS MARIA LAGO F4 CALLE MARGARITA ESTEVA
UTUADO PR
00641
US

IV. Provider business mailing address

URB. JESUS MARIA LAGO F4 CALLE MARGARITA ESTEVA
UTUADO PR
00641
US

V. Phone/Fax

Practice location:
  • Phone: 787-314-8582
  • Fax:
Mailing address:
  • Phone: 787-314-8582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13068
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: