Provider Demographics
NPI:1558576991
Name:MONROIG-LOPEZ, MADELISA (MS)
Entity Type:Individual
Prefix:MS
First Name:MADELISA
Middle Name:
Last Name:MONROIG-LOPEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AF9 CALLE TORREON
Mailing Address - Street 2:VENUS GARDENS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4721
Mailing Address - Country:US
Mailing Address - Phone:787-760-9481
Mailing Address - Fax:787-763-3681
Practice Address - Street 1:7 GUARIONEX
Practice Address - Street 2:LOCAL 2
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-767-3655
Practice Address - Fax:787-763-3681
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2566103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2566OtherPROFESSIONAL LICENCE