Provider Demographics
NPI:1467822189
Name:LIZZETTE LOPEZ RODRIGUEZ
Entity Type:Organization
Organization Name:LIZZETTE LOPEZ RODRIGUEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHISICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIZZETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-560-0724
Mailing Address - Street 1:H69 CALLE 8
Mailing Address - Street 2:URB DEL CARMEN
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:H69 CALLE 8
Practice Address - Street 2:URB DEL CARMEN
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627
Practice Address - Country:US
Practice Address - Phone:787-560-0724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1058-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy