Provider Demographics
NPI:1083320345
Name:LOPEZ, LUZ M
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:M
Last Name: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 1:243 CALLE PARIS
Mailing Address - Street 2:PMB 1134
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-3632
Mailing Address - Country:US
Mailing Address - Phone:787-910-9391
Mailing Address - Fax:
Practice Address - Street 1:AL14 CALLE 15
Practice Address - Street 2:
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-3419
Practice Address - Country:US
Practice Address - Phone:787-910-9391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11427104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR11427OtherSOCIAL WORKER