Provider Demographics
NPI:1952631061
Name:LOPEZ SANTOS, JUAN E
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:E
Last Name:LOPEZ SANTOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VISTA SERENA 920
Mailing Address - Street 2:SUITE T 301
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:939-251-7182
Mailing Address - Fax:787-998-0735
Practice Address - Street 1:PARQUE TERRALINDA,
Practice Address - Street 2:APT.KK-2, BOX1202
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-293-4601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR003255103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling