Provider Demographics
NPI:1649598046
Name:LOPEZ, DIVINA ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:DIVINA
Middle Name:ELIZABETH
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-1563
Mailing Address - Country:US
Mailing Address - Phone:201-842-0501
Mailing Address - Fax:201-842-9190
Practice Address - Street 1:338 UNION AVE
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-1563
Practice Address - Country:US
Practice Address - Phone:201-842-0501
Practice Address - Fax:201-842-9190
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 107103208000000X
NJ25MA08828200208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics