=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396536629
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SONIBETH LOPEZ DEL VALLE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2025
-----------------------------------------------------
Last Update Date | 05/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2214 CINDER CT
-----------------------------------------------------
City | JUNCTION CITY
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66441-2798
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-485-4911
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | K17 CALLE 10
-----------------------------------------------------
City | CAROLINA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00987-5447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-485-4911
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 150.113995
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 16627
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------