Provider Demographics
NPI:1275038820
Name:LOPEZ, SANDRA DE LOURDES (MS)
Entity Type:Individual
Prefix:
First Name:SANDRA DE
Middle Name:LOURDES
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB CAMINO DEL MAR
Mailing Address - Street 2:9529 PLAZA LAS GARZAS
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-612-2836
Mailing Address - Fax:
Practice Address - Street 1:GALERIA CONDADO AVENIDA ASHFORD
Practice Address - Street 2:SUITE 609
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-612-2836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR005817103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling