Provider Demographics
NPI:1396359774
Name:LOPEZ RODRIGUEZ, EDIANIE
Entity Type:Individual
Prefix:
First Name:EDIANIE
Middle Name:
Last Name:LOPEZ RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 4 BOX 14053
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-9574
Mailing Address - Country:US
Mailing Address - Phone:787-451-7010
Mailing Address - Fax:
Practice Address - Street 1:RR 4 BOX 14053
Practice Address - Street 2:
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610-9574
Practice Address - Country:US
Practice Address - Phone:787-451-7010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical