Provider Demographics
NPI:1790868537
Name:LOPEZ-ATIENZA, MARIA C (OD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:C
Last Name:LOPEZ-ATIENZA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:B5 CALLE TABONUCO
Mailing Address - Street 2:STE 216 PMB212
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-3004
Mailing Address - Country:US
Mailing Address - Phone:787-273-0490
Mailing Address - Fax:787-273-0666
Practice Address - Street 1:LOCAL F10
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968
Practice Address - Country:US
Practice Address - Phone:787-273-0490
Practice Address - Fax:787-273-0666
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR243152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRU11700Medicare UPIN