Provider Demographics
NPI:1245552793
Name:LOPEZ-OSORIO, MARIA DE LOS ANGELES (PHD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:DE LOS ANGELES
Last Name:LOPEZ-OSORIO
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:BOSQUE DE LAS PALMAS 188 COCOPLUMOSO STREET
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-9250
Mailing Address - Country:US
Mailing Address - Phone:939-639-6642
Mailing Address - Fax:
Practice Address - Street 1:URB. ROOSEVELT #458 CALLE JOSE CANALS
Practice Address - Street 2:SUITE 101
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:939-639-6642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3577103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist