Provider Demographics
NPI:1598403412
Name:CRUZ LOPEZ, FABIOLA (PHD, MPH)
Entity Type:Individual
Prefix:DR
First Name:FABIOLA
Middle Name:
Last Name:CRUZ LOPEZ
Suffix:
Gender:F
Credentials:PHD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 CALLE TAMPA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-3434
Mailing Address - Country:US
Mailing Address - Phone:787-579-7313
Mailing Address - Fax:
Practice Address - Street 1:333 CALLE TAMPA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-3434
Practice Address - Country:US
Practice Address - Phone:787-579-7313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program