Provider Demographics
NPI:1891068177
Name:LOPEZ-CEPERO, MARIANA (LND)
Entity Type:Individual
Prefix:MS
First Name:MARIANA
Middle Name:
Last Name:LOPEZ-CEPERO
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:REPARTO PINERO NUMBER 20
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-244-3425
Mailing Address - Fax:
Practice Address - Street 1:REPARTO PINERO NUMBER 20
Practice Address - Street 2:SUITE 201
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-244-3425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1642133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist