Provider Demographics
NPI:1962643676
Name:AVILA-LOPEZ, DYHALMA NATACHA (PHD)
Entity Type:Individual
Prefix:DR
First Name:DYHALMA
Middle Name:NATACHA
Last Name:AVILA-LOPEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:QQ19 CALLE ARTEMISA
Mailing Address - Street 2:APOLO
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5018
Mailing Address - Country:US
Mailing Address - Phone:787-287-1731
Mailing Address - Fax:
Practice Address - Street 1:265 CALLE SIERRA MORENA
Practice Address - Street 2:LA CUMBRE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-5539
Practice Address - Country:US
Practice Address - Phone:787-287-1731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2160103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist