Healthcare Provider Details

I. General information

NPI: 1669748935
Provider Name (Legal Business Name): WIZEIDA I LOPEZ R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2012
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 693 KM 14.2
VEGA ALTA PR
00692
US

IV. Provider business mailing address

PO BOX 468
VEGA BAJA PR
00694-0468
US

V. Phone/Fax

Practice location:
  • Phone: 787-270-2686
  • Fax: 787-270-5209
Mailing address:
  • Phone: 787-270-2686
  • Fax: 787-270-5292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number010445
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number010445
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: