Provider Demographics
NPI:1336576388
Name:LOPEZ, DORA OLIVA
Entity Type:Individual
Prefix:MRS
First Name:DORA
Middle Name:OLIVA
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:PO BOX 803
Mailing Address - Street 2:
Mailing Address - City:NAGUABO
Mailing Address - State:PR
Mailing Address - Zip Code:00718-0803
Mailing Address - Country:US
Mailing Address - Phone:787-530-7821
Mailing Address - Fax:
Practice Address - Street 1:STREET 8 INT 5. DISTRIC DUQUE
Practice Address - Street 2:
Practice Address - City:NAGUABO
Practice Address - State:PR
Practice Address - Zip Code:00718-0803
Practice Address - Country:US
Practice Address - Phone:787-530-7821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-07
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1643133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist