Provider Demographics
NPI:1659667368
Name:DIEPPA LOPEZ DE VICTORIA, NATALIA M (PSYD)
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:M
Last Name:DIEPPA LOPEZ DE VICTORIA
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 7004
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7004
Mailing Address - Country:US
Mailing Address - Phone:939-640-1546
Mailing Address - Fax:
Practice Address - Street 1:URB. INDUSTRIAL REPARADA 2
Practice Address - Street 2:396 DR. LUIS F. SALA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:939-640-1546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3998103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical