Provider Demographics
NPI:1578615753
Name:RIVERA LOPEZ, LUZ EDMARIS (AUD)
Entity Type:Individual
Prefix:DR
First Name:LUZ
Middle Name:EDMARIS
Last Name:RIVERA LOPEZ
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 7532
Mailing Address - Street 2:
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766-9857
Mailing Address - Country:US
Mailing Address - Phone:939-940-9265
Mailing Address - Fax:787-848-8179
Practice Address - Street 1:2225 PONCE BYP
Practice Address - Street 2:EDIFICIO PARRA SUITE 406
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1321
Practice Address - Country:US
Practice Address - Phone:787-844-8595
Practice Address - Fax:787-848-8179
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR571231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist