Provider Demographics
NPI:1669625943
Name:LOPEZ, GABRIELA E (LND)
Entity Type:Individual
Prefix:MRS
First Name:GABRIELA
Middle Name:E
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 CALLE ROOSEVELT
Mailing Address - Street 2:APT 3
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-3409
Mailing Address - Country:US
Mailing Address - Phone:787-777-3535
Mailing Address - Fax:787-777-3262
Practice Address - Street 1:652 CALLE ROOSEVELT
Practice Address - Street 2:APT 3
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-3409
Practice Address - Country:US
Practice Address - Phone:787-777-3535
Practice Address - Fax:787-777-3262
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1327133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist