Provider Demographics
NPI:1619654977
Name:PEREZ LOPEZ, STEPHANIE (DOCTOR)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:PEREZ LOPEZ
Suffix:
Gender:F
Credentials:DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 PASEO DE LA PALMA REAL
Mailing Address - Street 2:URB. EL VALLE
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CALLE TURQUESA 2118, SUITE 201-B
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-4960
Practice Address - Country:US
Practice Address - Phone:787-708-9093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6868103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical