Provider Demographics
NPI:1023093176
Name:LOPEZ, GUADALUPE G
Entity type:Individual
Prefix:MRS
First Name:GUADALUPE
Middle Name:G
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:CALLE 46 SE 1187
Mailing Address - Street 2:REPARTO METROPOLITONO RIO DIERES
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921
Mailing Address - Country:US
Mailing Address - Phone:787-767-7676
Mailing Address - Fax:787-281-0194
Practice Address - Street 1:AVE 65 INFANTERIA K-M 3.4
Practice Address - Street 2:BARRIO SABANA LLANA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:787-769-7676
Practice Address - Fax:787-281-0194
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR025987163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse