Provider Demographics
NPI:1942601513
Name:LOPEZ-VEGA, LOURDES A (PHYCOLOGIST)
Entity Type:Individual
Prefix:MRS
First Name:LOURDES
Middle Name:A
Last Name:LOPEZ-VEGA
Suffix:
Gender:F
Credentials:PHYCOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 142881
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-2881
Mailing Address - Country:US
Mailing Address - Phone:787-383-3229
Mailing Address - Fax:
Practice Address - Street 1:1 RES TRINA PADILLA
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4009
Practice Address - Country:US
Practice Address - Phone:787-383-3229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-14
Last Update Date:2014-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103T00000XBehavioral Health & Social Service ProvidersPsychologist