Provider Demographics
NPI:1942668579
Name:LOPEZ, BRUNILDA
Entity Type:Individual
Prefix:MS
First Name:BRUNILDA
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:ESCORIAL 701
Mailing Address - Street 2:SAN JUAN, PUERTO RICO USA
Mailing Address - City:SAN JUAN, PUERTO RICO
Mailing Address - State:PR
Mailing Address - Zip Code:00920
Mailing Address - Country:US
Mailing Address - Phone:787-725-2202
Mailing Address - Fax:787-977-0204
Practice Address - Street 1:701 AVE ESCORIAL
Practice Address - Street 2:SAN JUAN, PUERTO RICO USA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-4732
Practice Address - Country:US
Practice Address - Phone:787-725-2202
Practice Address - Fax:787-977-0204
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1545183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1545OtherPHARMACY TECHNITIAN