Provider Demographics
NPI:1003826637
Name:LOPEZ, LIZAIDA (PSYD)
Entity Type:Individual
Prefix:
First Name:LIZAIDA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1979 CALLE SAUCO
Mailing Address - Street 2:SAN RAMN
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-3938
Mailing Address - Country:US
Mailing Address - Phone:787-510-6084
Mailing Address - Fax:
Practice Address - Street 1:1994 AVE EMILIANO POL
Practice Address - Street 2:LA ALAMEDA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-5502
Practice Address - Country:US
Practice Address - Phone:787-510-6084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1909103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR62165Medicare ID - Type Unspecified