MEDICARE: KARYNA MICHELLE LOPEZ SANTIAGO TMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	13418	PR
2	103TC0700X	Clinical Psychologist	8436	PR

General Provider Information

NPI Number	:	1871311514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARYNA MICHELLE LOPEZ SANTIAGO TMS

Provider Business Mailing Address
First Line	:	URB JARDINES DE SANTO DOMINGO CALLE 2 G2
Second Line	:
City	:	JUANA DIAZ
State	:	PR
Zip	:	00795
Country	:	US
Telephone Number	:	787-298-7101
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 CALLE RAMON E BETANCES
Second Line	:
City	:	SANTA ISABEL
State	:	PR
Zip	:	00757-2632
Country	:	US
Telephone Number	:	787-845-6000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2024
Last Update Date	:	09/28/2025

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