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General NPI Number Information
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NPI Number | 1639202039
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Entity Type | Individual
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Provider Name | JOSE LUIS LOPEZ
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Gender | Male
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1324 CALLE CANADA ANTIGUO HOSP DE VETERANO PUERTO NUEVO
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City | SAN JUAN
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State | PR
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Zip | 00920-3860
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Country | US
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Telephone | 787-791-1551
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Fax |
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Provider Business Mailing Address
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Address Line | 1019 CALLE NAVARRA VISTA MAR
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City | CAROLINA
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State | PR
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Zip | 00983-1642
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1857
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License Number State | PR
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