Provider Demographics
NPI:1629008255
Name:LOPEZ, NILSA (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:NILSA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PSYD
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 71474
Mailing Address - Street 2:APS CLINICS OF PR INC
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8574
Mailing Address - Country:US
Mailing Address - Phone:787-641-0774
Mailing Address - Fax:787-641-2759
Practice Address - Street 1:AVE PONCE DE LEON
Practice Address - Street 2:ESQ DEL PARQUE #22
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00913
Practice Address - Country:US
Practice Address - Phone:787-641-0774
Practice Address - Fax:787-641-2759
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1300103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical