Provider Demographics
NPI:1457303257
Name:LOPEZ RODRIGUEZ, MARITZA (OD)
Entity Type:Individual
Prefix:DR
First Name:MARITZA
Middle Name:
Last Name:LOPEZ RODRIGUEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB LA CONCEPCION ROSARIO ST 133
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623
Mailing Address - Country:US
Mailing Address - Phone:787-399-7831
Mailing Address - Fax:787-832-5540
Practice Address - Street 1:975 AVE HOSTOS
Practice Address - Street 2:SUITE 62
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-1251
Practice Address - Country:US
Practice Address - Phone:787-832-5540
Practice Address - Fax:787-832-5540
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR358152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist