Provider Demographics
NPI:1275087090
Name:LOPEZ CRUZ, YOMAIRA ZAHIRA (PHD)
Entity Type:Individual
Prefix:DR
First Name:YOMAIRA
Middle Name:ZAHIRA
Last Name:LOPEZ CRUZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 943
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-0943
Mailing Address - Country:US
Mailing Address - Phone:787-675-0663
Mailing Address - Fax:787-691-8018
Practice Address - Street 1:554 CALLE ALDEBARAN
Practice Address - Street 2:EDGEWELL BUILDING SUITE 104
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-4252
Practice Address - Country:US
Practice Address - Phone:787-675-0663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-10
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5683103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical