Provider Demographics
NPI:1508180027
Name:LOPEZ, WALESKA (LICENSE)
Entity Type:Individual
Prefix:
First Name:WALESKA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LICENSE
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 544
Mailing Address - Street 2:
Mailing Address - City:MERCEDITA
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0544
Mailing Address - Country:US
Mailing Address - Phone:787-943-8961
Mailing Address - Fax:
Practice Address - Street 1:ST TROPEZ BUILDING
Practice Address - Street 2:6267 ISLA VERDE AVE
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979
Practice Address - Country:US
Practice Address - Phone:787-943-8961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR615251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health