Provider Demographics
NPI:1609650787
Name:LOPEZ SERRANO, DAMARIS EVELISSE (RN)
Entity Type:Individual
Prefix:
First Name:DAMARIS
Middle Name:EVELISSE
Last Name:LOPEZ SERRANO
Suffix:
Gender:F
Credentials:RN
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 521
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-0521
Mailing Address - Country:US
Mailing Address - Phone:787-549-1229
Mailing Address - Fax:
Practice Address - Street 1:CALLE 9A NUM 56
Practice Address - Street 2:COMUNIDAD MONSERRATE
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-549-1229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR86483163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice