Provider Demographics
NPI:1326708900
Name:LOPEZ POMALES, ARISSAY (000156-PA)
Entity Type:Individual
Prefix:
First Name:ARISSAY
Middle Name:
Last Name:LOPEZ POMALES
Suffix:
Gender:F
Credentials:000156-PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URBANIZACION HORIZONTE CALLE ALEGRIA F24
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:787-396-9846
Mailing Address - Fax:
Practice Address - Street 1:CALLE SAN RAFAEL 1396
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00910
Practice Address - Country:US
Practice Address - Phone:787-982-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000156-P.A.363AM0700X
PR000156-P.A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical