Provider Demographics
NPI:1790402212
Name:LOPEZ CASTRO, LOURDES MILAGROS
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:MILAGROS
Last Name:LOPEZ CASTRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LOURDES
Other - Middle Name:MILAGROS
Other - Last Name:LOPEZ CASTRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:KENT K 6
Mailing Address - Street 2:VILLA DEL REY 1 SECC
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-638-4246
Mailing Address - Fax:
Practice Address - Street 1:KENT K 6
Practice Address - Street 2:VILLA DEL REY 1 SECC
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-638-4246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR138581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty