Provider Demographics
NPI:1902377500
Name:LOPEZ, ISSAMAR
Entity Type:Individual
Prefix:MS
First Name:ISSAMAR
Middle Name:
Last Name: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 1:1201 JEFFERSON AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-5111
Mailing Address - Country:US
Mailing Address - Phone:347-247-3472
Mailing Address - Fax:
Practice Address - Street 1:1201 JEFFERSON AVE APT 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-5111
Practice Address - Country:US
Practice Address - Phone:347-247-3472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-08
Last Update Date:2018-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator