Provider Demographics
NPI:1265816771
Name:LOPEZ, DESIREE (RND)
Entity Type:Individual
Prefix:MISS
First Name:DESIREE
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:D20 CALLE 10
Mailing Address - Street 2:URBANIZACION DIPLO
Mailing Address - City:NAGUABO
Mailing Address - State:PR
Mailing Address - Zip Code:00718
Mailing Address - Country:US
Mailing Address - Phone:787-222-4270
Mailing Address - Fax:
Practice Address - Street 1:D20 CALLE 10
Practice Address - Street 2:URBANIZACION DIPLO
Practice Address - City:NAGUABO
Practice Address - State:PR
Practice Address - Zip Code:00718
Practice Address - Country:US
Practice Address - Phone:787-222-4270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1860133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered