Provider Demographics
NPI:1083877153
Name:LOPEZ, REBECA (MSSP)
Entity Type:Individual
Prefix:MRS
First Name:REBECA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MSSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 CALLE FRAY GRANADA
Mailing Address - Street 2:EL SENORIAL
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6942
Mailing Address - Country:US
Mailing Address - Phone:787-409-4226
Mailing Address - Fax:
Practice Address - Street 1:PROLONGACION 19 NE
Practice Address - Street 2:
Practice Address - City:PUERTO NUEVO
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-449-0607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR308235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist