Provider Demographics
NPI:1558122796
Name:LOPEZ, PAOLA INES
Entity Type:Individual
Prefix:
First Name:PAOLA
Middle Name:INES
Last Name:LOPEZ
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:COALICION DE COALICIONES 606
Mailing Address - Street 2:AVE. TITO CASTRO SUITE 201B
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730
Mailing Address - Country:US
Mailing Address - Phone:787-617-4272
Mailing Address - Fax:
Practice Address - Street 1:COALICION DE COALICIONES 606
Practice Address - Street 2:AVE. TITO CASTRO SUITE 201B
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730
Practice Address - Country:US
Practice Address - Phone:787-848-3073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic