Provider Demographics
NPI:1619635091
Name:LOPEZ ROBLES, VICTOR ALEJANDRO (MT(ASCP), NL)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:ALEJANDRO
Last Name:LOPEZ ROBLES
Suffix:
Gender:M
Credentials:MT(ASCP), NL
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 546
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-0546
Mailing Address - Country:US
Mailing Address - Phone:787-242-5479
Mailing Address - Fax:
Practice Address - Street 1:4030 AVE MILITAR
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-4154
Practice Address - Country:US
Practice Address - Phone:787-830-8855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR137175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath