Provider Demographics
NPI:1841604170
Name:ZAMORA LOPEZ, MARY JOSE
Entity Type:Individual
Prefix:
First Name:MARY JOSE
Middle Name:
Last Name:ZAMORA LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 AVE LOS MAESTROS
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-5952
Mailing Address - Country:US
Mailing Address - Phone:787-833-7434
Mailing Address - Fax:
Practice Address - Street 1:22 AVE LOS MAESTROS
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-5952
Practice Address - Country:US
Practice Address - Phone:787-833-7434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-14
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
283Q00000X
PR021240208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No283Q00000XHospitalsPsychiatric Hospital