Provider Demographics
NPI:1083248116
Name:CEBOLLERO LOPEZ, ANA ROSA
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:ROSA
Last Name:CEBOLLERO LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 CALLE MIRAMAR
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-5836
Mailing Address - Country:US
Mailing Address - Phone:787-238-7974
Mailing Address - Fax:
Practice Address - Street 1:EDIFICIO DR. GUILLERMO ARBONA IRRIZARY, 3ER PISO
Practice Address - Street 2:AREA CENTRO MEDICO
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00935
Practice Address - Country:US
Practice Address - Phone:787-758-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health