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General NPI Number Information
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NPI Number | 1902568983
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Entity Type | Individual
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Provider Name | GLORIA LOPEZ
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Gender | Female
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Dates
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Enumeration Date | 10/07/2021
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Last Update Date | 10/08/2021
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Provider Practice Location Address
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Address Line | CARR. 153 KM 12.4 LOCAL 3 BO LAS FLORES
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City | COAMO
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State | PR
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Zip | 00769
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Country | US
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Telephone | 787-901-0381
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Fax |
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Provider Business Mailing Address
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Address Line | 11216 CALLE CALVEL HACIENDA CONCORDIA
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City | SANTA ISABEL
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State | PR
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Zip | 00757
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Country | US
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Telephone | 787-901-0381
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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 | 224ZL0004X
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Taxonomy Name | Low Vision Occupational Therapy Assistant
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License Number | 1363
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 1363
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License Number State | PR
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