Provider Demographics
NPI:1205163755
Name:ROMERO LOPEZ, DORIS I (MA)
Entity type:Individual
Prefix:MS
First Name:DORIS
Middle Name:I
Last Name:ROMERO LOPEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1274
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602
Mailing Address - Country:UM
Mailing Address - Phone:787-449-5428
Mailing Address - Fax:
Practice Address - Street 1:112 AVE. NATIVO ALERS DESVIO SUR
Practice Address - Street 2:BO. PIEDRAS BLANCAS SUITE 112
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-449-0449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001582103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1582OtherPSICOLOGIST
PR001582OtherINTERNATIONAL