Provider Demographics
NPI:1619114980
Name:LOPEZ, MARITZA (BA)
Entity Type:Individual
Prefix:
First Name:MARITZA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CALLE ACAPULCO
Mailing Address - Street 2:RES. VISTA MAR
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-2392
Mailing Address - Country:US
Mailing Address - Phone:787-872-8864
Mailing Address - Fax:
Practice Address - Street 1:4406 AVE MILITAR
Practice Address - Street 2:COTTO
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-4158
Practice Address - Country:US
Practice Address - Phone:787-872-5943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4753183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist