Provider Demographics
NPI:1639100175
Name:MENDEZ LOPEZ, DEIRIERIS (OTL)
Entity Type:Individual
Prefix:MRS
First Name:DEIRIERIS
Middle Name:
Last Name:MENDEZ LOPEZ
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3039 CALLE MALAGA
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-8965
Mailing Address - Country:US
Mailing Address - Phone:787-923-8271
Mailing Address - Fax:
Practice Address - Street 1:3039 CALLE MALAGA
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-8965
Practice Address - Country:US
Practice Address - Phone:787-923-8271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR901225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5-7892Medicare ID - Type UnspecifiedOCCUPATIONAL THERAPIST